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<1>
Accession Number
628528012
Title
A randomized, controlled pilot clinical trial of cryopreserved platelets
for perioperative surgical bleeding: the CLIP-I trial (Editorial, p.
2759).
Source
Transfusion. 59 (9) (pp 2794-2804), 2019. Date of Publication: 01 Sep
2019.
Author
Reade M.C.; Marks D.C.; Bellomo R.; Deans R.; Faulke D.J.; Fraser J.F.;
Gattas D.J.; Holley A.D.; Irving D.O.; Johnson L.; Pearse B.L.; Royse
A.G.; Wong J.; Weinberg L.; Eastwood G.; Peck L.; Young H.; Sidiropoulos
S.; Baulch S.; Dalyell A.; Kolar D.; Martinelli T.; Reidy Y.; Caldwell N.;
Royse A.; Tivendale L.; Bisignano M.; Hausler M.; Williams Z.; Dong N.;
Buhr H.; Bannon P.; Cartwright B.; Turner L.; Gibson J.; Blayney B.;
Beattie L.; Hutch D.; Wun Jennifer Coles J.; Pearse B.; Faulke D.;
Zeigenfuss M.; Tesar P.; Fraser J.; Perel J.; Kahn C.; Vincent B.; O'Brien
D.; Holley A.; Irving D.
Institution
(Reade) Joint Health Command, Australian Defence Force, Canberra, ACT,
Australia
(Reade, Deans, Holley) University of Queensland, Brisbane, QLD, Australia
(Marks, Irving, Johnson, Wong) Australian Red Cross Blood Service, Sydney,
NSW, Australia
(Bellomo) Austin Hospital, Melbourne, VIC, Australia
(Faulke, Fraser, Pearse) The Prince Charles Hospital, Brisbane, QLD,
Australia
(Gattas) Royal Prince Alfred Hospital, Sydney, NSW, Australia
(Royse) Royal Melbourne Hospital, Melbourne, VIC, Australia
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Cryopreservation extends platelet (PLT) shelf life from 5 to 7
days to 2 to 4 years. However, only 73 patients have been transfused
cryopreserved PLTs in published randomized controlled trials (RCTs),
making safety data insufficient for regulatory approval. STUDY DESIGN AND
METHODS: The Cryopreserved vs. Liquid Platelet (CLIP) study was a
double-blind, pilot, multicenter RCT involving high-risk cardiothoracic
surgical patients in four Australian hospitals. The objective was to test,
as the primary outcome, the feasibility and safety of the protocol.
Patients were allocated to study group by permuted block randomization,
with patients and clinicians blinded by use of an opaque shroud placed
over each study PLT unit. Up to 3 units of cryopreserved or liquid-stored
PLTs were administered per patient. No other aspect of patient care was
affected. Adverse events were actively sought. RESULT(S): A total of
121 patients were randomized, of whom 23 received cryopreserved PLTs and
18 received liquid-stored PLTs. There were no differences in blood loss
(median, 715 mL vs. 805 mL at 24 hr; difference between groups 90 mL [95%
CI, -343.8 to 163.8 mL], p = 0.41), but the Bleeding Academic Research
Consortium criterion for significant postoperative hemorrhage in cardiac
surgery composite bleeding endpoint occurred in nearly twice as many
patients in the liquid-stored group (55.6% vs. 30.4%, p = 0.10). Red blood
cell transfusion requirements were a median of 3 units in the
cryopreserved group versus 4 units with liquid-stored PLTs (difference
between groups, 1 unit [95% CI, -3.1 to 1.1 units]; p = 0.23). Patients in
the cryopreserved group were more likely to be transfused fresh-frozen
plasma (78.3% vs. 27.8%, p = 0.002) and received more study PLT units
(median, 2 units vs. 1 unit; difference between groups, 1 unit [95% CI,
-0.03 to 2.0 units]; p = 0.012). There were no between-group differences
in potential harms including deep venous thrombosis, myocardial
infarction, respiratory function, infection, and renal function. No
patient had died at 28 days, and postoperative length of stay was similar
in each group. CONCLUSION(S): In this pilot RCT, compared to
liquid-stored PLTs, cryopreserved PLTs were associated with no evidence of
harm. A definitive study testing safety and hemostatic effectiveness is
warranted. Copyright © 2019 AABB

<2>
Accession Number
2002885325
Title
Association Between Baseline, Achieved, and Reduction of CRP and
Cardiovascular Outcomes After LDL Cholesterol Lowering with Statins or
Ezetimibe: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 8 (16) (no pagination), 2019.
Article Number: e012428. Date of Publication: 20 Aug 2019.
Author
Zhang X.-L.; Lan R.-F.; Zhang X.-W.; Xu W.; Wang L.; Kang L.-N.; Xu B.
Institution
(Zhang, Lan, Xu, Wang, Kang, Xu) Department of Cardiology, Affiliated Drum
Tower Hospital, Nanjing University School of Medicine, Nanjing, China
(Zhang) Department of Endocrinology, Affiliated Drum Tower Hospital,
Nanjing University School of Medicine, Nanjing, China
Publisher
American Heart Association Inc.
Abstract
Background: Several lipid-lowering therapies reduce CRP (C-reactive
protein) independently of LDL-C (low-density lipoprotein cholesterol)
reduction, but the association between CRP parameters and benefits from
more-intensive LDL-C lowering is inconclusive. We aimed to determine
whether the benefits of more- versus less-intensive LDL-C lowering on
cardiovascular events related to baseline, achieved, or magnitude of
reduction in CRP concentrations. Methods and Results: PubMed, EMBASE,
and Cochrane were searched through July 2, 2018. We included randomized
controlled cardiovascular outcome trials of LDL-C lowering with statins or
ezetimibe. Two reviewers independently extracted study data and rated
study quality. Data were analyzed using meta-analysis and metaregression
analysis. Rate ratios of mortality and cardiovascular outcomes associated
with baseline, achieved, and magnitude reduction of CRP concentration were
calculated. Twenty-four trials were included, with 171 250 patients
randomly assigned to more- or less-intensive LDL-C-lowering treatments.
Median follow-up duration was 4.2 years. More-intensive LDL-C lowering
resulted in a significant reduction in incidences of all outcomes.
Compared with less-intensive LDL-C lowering, more-intensive LDL-C lowering
was associated with less reductions in myocardial infarction with a higher
baseline CRP concentration (change in rate ratios per 1-mg/L increase in
log-transformed CRP, 1.12 [95% CI, 1.04-1.22; P=0.007]), but not other
outcomes. Similar risk reductions occurred for more- versus less-intensive
LDL-C-lowering therapy regardless of the magnitude of CRP reduction or the
achieved CRP level for all outcomes. Conclusion(s): Baseline CRP
concentrations might be associated with the benefits of LDL-C lowering on
myocardial infarction, but no other outcomes, whereas the achieved and
magnitude of reduction in CRP did not seem to have an important
association. Copyright © 2019 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<3>
Accession Number
629547814
Title
Effects of foot reflexology on post-sternotomy hemodynamic status and pain
in patients undergoing coronary artery bypass graft: A randomized clinical
trial.
Source
Crescent Journal of Medical and Biological Sciences. 6 (4) (pp 517-522),
2019. Date of Publication: 2019.
Author
Hashemzadeh K.; Dehdilani M.; Gol M.K.
Institution
(Hashemzadeh) Department of Heart Surgery, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Dehdilani) Department of Anesthesiology, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Gol) Responsible for the Nursing Research Committee of Imam Reza
Hospital, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Publisher
Aras Part Medical International Press (E-mail: Publish@pmcaras.com)
Abstract
Objectives: There are contradictory results regarding the effects of foot
reflexology on postoperative pain and hemodynamic status in patients
undergoing coronary artery bypass graft (CABG). Therefore, the present
study aimed to investigate the effects of foot reflexology on
post-sternotomy pain and physiological parameters in patients undergoing
CABG. Material(s) and Method(s): This randomized clinical trial was
conducted on 40 women in Shahid Madani hospital of Tabriz in 2019. The
sample size was determined based on previous studies using a formula and
the participants were randomly assigned to treatment (n=20) and control
(n=20) groups. In addition, all participants completed a three-part
questionnaire (i.e., demographics, the visual analog scale, and
hemodynamic symptoms forms) before and 40 minutes after the intervention.
Then, the women in the test group received 20 minutes of left foot
reflexology based on the existing method while those in the control group
received no intervention. The data were statistically analyzed using the
Kolmogorov-Smirnov and chi-square tests, as well as the paired sample and
independent t tests at the significance level less than 0.05.
 Result(s): The results indicated that the intervention significantly
reduced systolic (P=0.001) and diastolic (P=0.005) blood pressures, along
with heart (P=0.003) and respiratory (P=0.041) rates. Further, foot
reflexology significantly decreased the severity of postoperative pain in
the treatment group (P=0.003). Conclusion(s): Overall, the study
findings revealed that foot reflexology had positive effects on the
stability of hemodynamic status and thus relieved postoperative pain in
patients undergoing CABG. Copyright © 2019 The Author(s); This is
an open-access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0), which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

<4>
Accession Number
2003305329
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in patients with three-vessel or left main coronary artery disease:
10-year follow-up of the multicentre randomised controlled SYNTAX trial.
Source
The Lancet. 394 (10206) (pp 1325-1334), 2019. Date of Publication: 12 - 18
October 2019.
Author
Thuijs D.J.F.M.; Kappetein A.P.; Serruys P.W.; Mohr F.-W.; Morice M.-C.;
Curzen N.; Davierwala P.; Noack T.; Milojevic M.; Dawkins K.D.; da Costa
B.R.; Juni P.; Head S.J.; Casselman F.; de Bruyne B.; Hoj Christiansen E.;
Ruiz-Nodar J.M.; Vermeersch P.; Schultz W.; Sabate M.; Guagliumi G.;
Grubitzsch H.; Stangl K.; Darremont O.; Bentala M.; den Heijer P.; Preda
I.; Stoler R.; Mack M.J.; Szerafin T.; Buckner J.K.; Guber M.S.;
Verberkmoes N.; Akca F.; Feldman T.; Beyersdorf F.; Drieghe B.; Oldroyd
K.; Berg G.; Jeppsson A.; Barber K.; Wolschleger K.; Heiser J.; van der
Harst P.; Mariani M.A.; Reichenspurner H.; Stark C.; Laine M.; Ho P.C.;
Chen J.C.; Zelman R.; Horwitz P.A.; Bochenek A.; Krauze A.; Grothusen C.;
Dudek D.; Heyrich G.; Kolh P.; LeGrand V.; Coelho P.; Ensminger S.;
Nasseri B.; Ingemansson R.; Olivecrona G.; Escaned J.; Guera R.; Berti S.;
Chieffo A.; Burke N.; Mooney M.; Spolaor A.; Hagl C.; Nabauer M.; Suttorp
M.J.; Stine R.A.; McGarry T.; Lucas S.; Endresen K.; Taussig A.; Accola
K.; Canosi U.; Horvath I.; Cannon L.; Talbott J.D.; Akins C.W.; Kramer R.;
Aschermann M.; Killinger W.; Narbute I.; Holmes D.R.; Burzotta F.; Bogers
A.; Zijlstra F.; Eltchaninoff H.; Berland J.; Stefanini G.; Cruz Gonzalez
I.; Hoppe U.; Kiesz S.; Gora B.; Ahlsson A.; Corbascio M.; Bilfinger T.;
Carrie D.; Tchetche D.; Hauptman K.-E.; Stahle E.; James S.; Sandner S.;
Laufer G.; Lang I.; Witkowski A.; Thourani V.; Suryapranata H.; Redwood
S.; Knight C.; MacCarthy P.; de Belder A.; Banning A.; Gershlick A.
Institution
(Thuijs, Kappetein, Milojevic, Head) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Mohr, Davierwala, Noack) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud,
Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy, France
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Centre, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Curzen) University Hospital Southampton NHS Foundation Trust and School
of Medicine, University of Southampton, Southampton, United Kingdom
(Dawkins) Shockwave Medical Inc., Santa Clara, CA, United States
(da Costa, Juni) Applied Health Research Centre, Li Ka Shing Knowledge
Institute of St Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Juni) Department of Medicine, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(da Costa) Institute of Primary Health Care, University of Bern, Bern,
Switzerland
(Head) Medtronic, Minneapolis, MN, United States
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The Synergy between PCI with Taxus and Cardiac Surgery
(SYNTAX) trial was a non-inferiority trial that compared percutaneous
coronary intervention (PCI) using first-generation paclitaxel-eluting
stents with coronary artery bypass grafting (CABG) in patients with
de-novo three-vessel and left main coronary artery disease, and reported
results up to 5 years. We now report 10-year all-cause death results.
 Method(s): The SYNTAX Extended Survival (SYNTAXES) study is an
investigator-driven extension of follow-up of a multicentre, randomised
controlled trial done in 85 hospitals across 18 North American and
European countries. Patients with de-novo three-vessel and left main
coronary artery disease were randomly assigned (1:1) to the PCI group or
CABG group. Patients with a history of PCI or CABG, acute myocardial
infarction, or an indication for concomitant cardiac surgery were
excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause
death, which was assessed according to the intention-to-treat principle.
Prespecified subgroup analyses were performed according to the presence or
absence of left main coronary artery disease and diabetes, and according
to coronary complexity defined by core laboratory SYNTAX score tertiles.
This study is registered with ClinicalTrials.gov, NCT03417050.
 Finding(s): From March, 2005, to April, 2007, 1800 patients were
randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status
information at 10 years was complete for 841 (93%) patients in the PCI
group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%)
patients had died after PCI and 211 (24%) after CABG (hazard ratio 1.17
[95% CI 0.97-1.41], p=0.092). Among patients with three-vessel disease,
151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG
(hazard ratio 1.41 [95% CI 1.10-1.80]), and among patients with left main
coronary artery disease, 93 (26%) of 357 had died after PCI versus 98
(28%) of 348 after CABG (0.90 [0.68-1.20], p<inf>interaction</inf>=0.019).
There was no treatment-by-subgroup interaction with diabetes
(p<inf>interaction</inf>=0.66) and no linear trend across SYNTAX score
tertiles (p<inf>trend</inf>=0.30). Interpretation(s): At 10 years, no
significant difference existed in all-cause death between PCI using
first-generation paclitaxel-eluting stents and CABG. However, CABG
provided a significant survival benefit in patients with three-vessel
disease, but not in patients with left main coronary artery disease.
 Funding(s): German Foundation of Heart Research (SYNTAXES study,
5-10-year follow-up) and Boston Scientific Corporation (SYNTAX study,
0-5-year follow-up). Copyright © 2019 Elsevier Ltd

<5>
Accession Number
2003305307
Title
Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen
after successful coronary stenting in patients with atrial fibrillation
(ENTRUST-AF PCI): a randomised, open-label, phase 3b trial.
Source
The Lancet. 394 (10206) (pp 1335-1343), 2019. Date of Publication: 12 - 18
October 2019.
Author
Vranckx P.; Valgimigli M.; Eckardt L.; Tijssen J.; Lewalter T.; Gargiulo
G.; Batushkin V.; Campo G.; Lysak Z.; Vakaliuk I.; Milewski K.; Laeis P.;
Reimitz P.-E.; Smolnik R.; Zierhut W.; Goette A.
Institution
(Vranckx) Department of Cardiology and Intensive Care, Jessa Ziekenhuis,
Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt,
Belgium
(Valgimigli, Gargiulo) Department of Cardiology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Eckardt, Lewalter, Goette) Atrial Fibrillation Network, Munster, Germany
(Eckardt) Department of Cardiology and Angiology, Division of
Electrophysiology, University of Munster, Munster, Germany
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers,
University of Amsterdam, Amsterdam, Netherlands
(Tijssen) Cardialysis, Rotterdam, Netherlands
(Lewalter) Department of Cardiology, Hospital Munich South, Munich,
Germany
(Lewalter) University of Bonn, Bonn, Germany
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Batushkin) Department of Cardiology, Kyiv City Clinical Hospital #5,
Kiev, Ukraine
(Campo) Cardiovascular Institute, Azienda Ospedaliero-Universitaria di
Ferrara, Cona, Venice, Italy
(Campo) Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
(Lysak) Department of Cardiac Rehabilitation, Oleksandrivska Kyiv City
Clinical Hospital, Kiev, Ukraine
(Milewski) Center for Cardiovascular Research and Development, American
Heart of Poland Katowice, Poland
(Milewski) The Jerzy Kukuczka Academy of Physical Education, Faculty of
Physiotherapy, Katowice, Katowice, Poland
(Vakaliuk) Department Internal Medicine No2 and Nursing, Ivano-Frankivsk
National Medical University, Ivano-Frankivsk, Ukraine
(Vakaliuk) Department of Anesthesiology with Wards of Intensive Care,
Ivano-Frankivsk Regional Clinical Cardiological Clinic, Ivano-Frankivsk,
Ukraine
(Laeis, Reimitz, Smolnik, Zierhut) Daiichi Sankyo Europe, Munich, Germany
(Goette) Cardiology and Intensive Care Medicine, St Vincenz-Hospital,
Paderborn, Germany
(Goette) Working Group of Molecular Electrophysiology, University Hospital
Magdeburg, Magdeburg, Germany
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: We aimed to assess the safety of edoxaban in combination with
P2Y12 inhibition in patients with atrial fibrillation who had percutaneous
coronary intervention (PCI). Method(s): ENTRUST-AF PCI was a
randomised, multicentre, open-label, non-inferiority phase 3b trial with
masked outcome evaluation, done at 186 sites in 18 countries. Patients had
atrial fibrillation requiring oral anticoagulation, were aged at least 18
years, and had a successful PCI for stable coronary artery disease or
acute coronary syndrome. Participants were randomly assigned (1:1) from 4
h to 5 days after PCI using concealed, stratified, and blocked web-based
central randomisation to either edoxaban (60 mg once daily) plus a P2Y12
inhibitor for 12 months or a vitamin K antagonist (VKA) in combination
with a P2Y12 inhibitor and aspirin (100 mg once daily, for 1-12 months).
The edoxaban dose was reduced to 30 mg per day if one or more factors
(creatinine clearance 15-50 mL/min, bodyweight <=60 kg, or concomitant use
of specified potent P-glycoprotein inhibitors) were present. The primary
endpoint was a composite of major or clinically relevant non-major (CRNM)
bleeding within 12 months. The primary analysis was done in the
intention-to-treat population and safety was assessed in all patients who
received at least one dose of their assigned study drug. This trial is
registered with ClinicalTrials.gov, NCT02866175, is closed to new
participants, and follow-up is completed. Finding(s): From Feb 24,
2017, through May 7, 2018, 1506 patients were enrolled and randomly
assigned to the edoxaban regimen (n=751) or VKA regimen (n=755). Median
time from PCI to randomisation was 45.1 h (IQR 22.2-76.2). Major or CRNM
bleeding events occurred in 128 (17%) of 751 patients (annualised event
rate 20.7%) with the edoxaban regimen and 152 (20%) of 755 patients
(annualised event rate 25.6%) patients with the VKA regimen; hazard ratio
0.83 (95% CI 0.65-1.05; p=0.0010 for non-inferiority, margin hazard ratio
1.20; p=0.1154 for superiority). Interpretation(s): In patients with
atrial fibrillation who had PCI, the edoxaban-based regimen was
non-inferior for bleeding compared with the VKA-based regimen, without
significant differences in ischaemic events. Funding(s): Daiichi
Sankyo. Copyright © 2019 Elsevier Ltd

<6>
Accession Number
2003288198
Title
Surgical decision making around paediatric preoperative anaemia in
low-income and middle-income countries.
Source
The Lancet Child and Adolescent Health. 3 (11) (pp 814-821), 2019. Date of
Publication: November 2019.
Author
Charuvila S.; Davidson S.E.; Thachil J.; Lakhoo K.
Institution
(Charuvila, Davidson, Lakhoo) Nuffield Department of Surgical Sciences,
University of Oxford, Oxford, United Kingdom
(Thachil) Department of Haematology Manchester University, Manchester,
United Kingdom
Publisher
Elsevier B.V.
Abstract
Prevalence of anaemia is high among children in low-income and
middle-income countries. Anaemia is an important factor to consider
preoperatively as low haemoglobin concentrations can have a negative
effect on surgical outcomes and can also lead to surgeries being cancelled
or postponed, which can have adverse health implications and stretch
already limited resources in these countries. Additionally, blood
transfusions to correct anaemia exposes children to safety issues.
Therefore, where anaemia is known to be prevalent and resources are
scarce, a contextually appropriate and relatively safe minimum haemoglobin
concentration for proceeding to surgery could substantially improve
patient management and efficiency of the health system. In this Review, we
consider why paediatric anaemia is a major public health issue in
low-income and middle-income countries, the value of preoperative testing
of anaemia, and methods of optimising haemoglobin concentrations in the
context of paediatric surgeries taking place in resource-limited
settings. Copyright © 2019 Elsevier Ltd

<7>
Accession Number
2001737966
Title
The Effect of Simultaneous Renal Replacement Therapy on Extracorporeal
Membrane Oxygenation Support for Postcardiotomy Patients with Cardiogenic
Shock: A Pilot Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 3063-3072),
2019. Date of Publication: November 2019.
Author
Li C.; Wang H.; Liu N.; Jia M.; Hou X.
Institution
(Li, Wang, Liu, Jia, Hou) Center for Cardiac Intensive Care, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: The objectives of this study were to determine the feasibility
and safety of simultaneous renal replacement therapy (RRT) during
extracorporeal membrane oxygenation (ECMO) support for postcardiotomy
patients with cardiogenic shock and whether simultaneous RRT with ECMO
would improve survival and reduce morbidity. The authors hypothesized that
simultaneous RRT could facilitate effective fluid management and rapid
metabolic control in postcardiotomy patients with cardiogenic shock who
were undergoing ECMO support. Design(s): A parallel, open-label,
single-center pilot randomized trial. Setting(s):
University-affiliated cardiac surgery intensive care unit.
 Participant(s): The study comprised 41 postcardiotomy patients with
cardiogenic shock who received ECMO support. Intervention(s):
Participants were enrolled and randomly assigned via a 1:1 allocation to a
simultaneous RRT arm versus a standard care arm. The patients in the
simultaneous RRT arm received RRT within 12 hours of the start of ECMO
regardless of the conventional RRT indication. Simultaneous RRT was
delivered with the RRT machine connected to the ECMO circuit. The patients
in the standard care arm did not receive RRT at the start of ECMO unless
the conventional RRT indications were fulfilled. Measurements and
Main Results: All 41 patients enrolled were followed-up for 30 days and
the results analyzed. The primary feasibility outcome was the time from
randomization to simultaneous RRT of <12 hours in the simultaneous RRT
arm. All participants in simultaneous RRT arm fulfilled with a median time
from randomization to simultaneous RRT of 4.4 (2.7-5.6) hours. The 30-day
all-cause mortality was 61.9% in the simultaneous RRT arm and 75.0% in the
standard care arm (p = 0.51). The lactate clearance was higher in the
simultaneous RRT arm (0.56 +/- 0.4 v 0.28 +/- 0.4 mmol/L/h; p = 0.04).
There was lower cumulative fluid balance in the simultaneous RRT arm on
ECMO day 3 (-1,510 [-3560 to 1,162] v -332 [-2,027 to 2,181]; p = 0.38)
and ECMO day 5 (-2,671 [-5,197 to 3,334] v -1,509 [-3,595 to 1,162]; p =
0.41) without significance. There were no significant differences in
adverse events reported and no hemodynamic instability owing to
simultaneous RRT delivery. Conclusion(s): This pilot study suggests
the feasibility and safety of simultaneous RRT during ECMO support for
postcardiotomy patients with cardiogenic shock, providing an efficient
means for controlling fluid status and metabolics. A large trial based on
this pilot study is required to confirm the clinical
benefits. Copyright © 2019 Elsevier Inc.

<8>
Accession Number
2001741548
Title
Intravenous Iron Versus Placebo in the Management of Postoperative
Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular
Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 2941-2948),
2019. Date of Publication: November 2019.
Author
Xu H.; Duan Y.; Yuan X.; Wu H.; Sun H.; Ji H.
Institution
(Xu, Duan, Yuan, Wu, Sun) Department of Adult Cardiac Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Science, Peking Union Medical College, Beijing, China
(Ji) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
Publisher
W.B. Saunders
Abstract
Objective: To compare the efficacy of intravenous iron versus placebo to
correct postoperative functional iron deficiency anemia in patients
undergoing cardiac valvular surgery. Design(s): A prospective,
single-blinded, randomized controlled study. Setting(s): National
Center for Cardiovascular Diseases and a university hospital.
 Participant(s): The study comprised 150 patients with postoperative
functional iron deficiency anemia after cardiac valvular surgery.
 Intervention(s): The patients were randomly assigned (1:1) to either
the treatment (intravenous iron) group or the control (placebo) group.
 Measurements and Main Results: The hemoglobin and ferritin
concentrations and postoperative adverse events were collected and
compared between the 2 groups. The hemoglobin concentration and the
proportion of patients who had their anemia corrected or achieved
hemoglobin increments of >20 g/L in the intravenous iron group were
significantly higher than that in the placebo group at postoperative day
14 (p = 0.023, p = 0.037, and p = 0.001), whereas there was no statistical
difference at postoperative day 7. The ferritin concentration was
substantially higher at postoperative day 7 and postoperative day 14 in
the intravenous iron group compared with the placebo group (both p <
0.001). There were no significant differences in rates of death, blood
tranfusion, antibiotic upgrade, ventilator time >24 hours, postoperative
hospital stay >10 days, poor wound healing, and perivalvular leakage
between the 2 groups. Conclusion(s): Intravenous iron could
significantly increase the hemoglobin level in patients with postoperative
functional iron deficiency anemia at postoperative day 14. However, there
is no difference in blood transfusion requirements or postoperative
adverse outcomes between the 2 groups. Copyright © 2019 Elsevier
Inc.

<9>
Accession Number
629579218
Title
Transfusion-related immunomodulation: gamma irradiation alters the effects
of leukoreduction on alloimmunization.
Source
Transfusion. (no pagination), 2019. Date of Publication: 13 Oct 2019.
Author
Nelson K.A.; Aldea G.S.; Warner P.; Latchman Y.; Gunasekera D.; Tamir A.;
Gernsheimer T.; Bolgiano D.; Slichter S.J.
Institution
(Nelson, Warner, Latchman, Gunasekera, Tamir, Gernsheimer, Bolgiano,
Slichter) Bloodworks Northwest, Seattle, WA, United States
(Aldea) Department of Surgery, Division of Cardiothoracic Surgery,
University of Washington, Seattle, WA, United States
(Latchman) SeattleWAUnited States
(Gunasekera) Uniformed Services University of Health Sciences, Bethesda,
MD, United States
(Gernsheimer, Slichter) Division of Hematology, University of Washington
School of Medicine, Seattle, WA, United States
(Gernsheimer, Slichter) Seattle Cancer Care Alliance, Seattle, WA, United
States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Adverse events following blood transfusion include
allosensitization and generalized immunosuppression, collectively referred
to as transfusion-related immune modulation. We evaluated the
immunological effects of red blood cell (RBC) and platelet transfusions on
alloantibody responses and on immunoregulatory cells in
nonimmunosuppressed patients undergoing cardiovascular surgery. STUDY
DESIGN AND METHODS: Patients were randomized to receive standard
unmodified (STD), leukoreduced (LR), or leukoreduced and gamma-irradiated
(LRgamma) RBCs. Patients received only apheresis platelets that were
in-process LR and were gamma-irradiated for the third arm. Nontransfused
patients served as controls for the effects of surgery itself on
immunologic changes. Antibodies to HLA were assessed with use of
solid-phase assays. The effects of transfusion on adaptive and innate
immunity were evaluated by assessing T regulatory cells (Tregs) and
invariant natural killer T (iNKT) cells. RESULT(S): LR of blood
products reduced the development of human leukocyte antigen (HLA)
alloantibodies, but only in patients without preexisting HLA antibodies.
However, if LR blood products were gamma-irradiated, HLA antibody
production was not reduced. Compared to nontransfused patients, recipients
of STD or LR transfusions showed a significant increase in CD4+CD25hi T
cells expressing FoxP3 or CTLA4 and also of iNKT cells producing
interleukin-4. In contrast, recipients of LRgamma blood products showed
markedly lower increases in all three cellular assays. CONCLUSION(S):
LR decreased HLA alloantibody production in naive recipients, but did not
reduce the immunosuppressive effects of transfusion. LRgamma reduced
immunosuppression and was not associated with decreased HLA alloantibody
production. Copyright © 2019 AABB.

<10>
Accession Number
629579058
Title
Antithrombotic strategies after transcatheter aortic valve implantation:
Insights from a network meta-analysis.
Source
Catheterization and cardiovascular interventions : official journal of the
Society for Cardiac Angiography & Interventions. (no pagination), 2019.
Date of Publication: 14 Oct 2019.
Author
Kuno T.; Takagi H.; Sugiyama T.; Ando T.; Miyashita S.; Valentin N.;
Shimada Y.J.; Kodaira M.; Numasawa Y.; Kanei Y.; Hayashida K.; Bangalore
S.
Institution
(Kuno, Miyashita, Valentin) Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, NY
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Sugiyama) Diabetes and Metabolism Information Center, Research Institute,
Center for Global Health and Medicine, Tokyo, Japan
(Sugiyama) Department of Health Services Research, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Sugiyama) Department of Public Health/Health Policy, Graduate School of
Medicine, University of Tokyo, Tokyo, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
(Shimada) Division of Cardiology, Department of Medicine, Columbia
University Medical Center, NY
(Kodaira, Numasawa) Department of Cardiology, Japanese Red Cross Ashikaga
Hospital, Ashikaga, Japan
(Kanei) Department of Cardiology, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
(Bangalore) New York University School of Medicine, NY
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We aimed to investigate the efficacy and safety of different
antithrombotic strategies in patients undergoing transcatheter aortic
valve implantation (TAVI) using network meta-analyses. BACKGROUND:
Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual
antiplatelet therapy (DAPT), +/- oral anticoagulant (OAC) was conducted to
determine the appropriate post TAVI antithrombotic regimen. However, there
was limited direct comparisons across the different therapeutic
strategies. METHOD(S): MEDLINE and EMBASE were searched through
December 2018 to investigate the efficacy and safety of different
antithrombotic strategies (SAPT, DAPT, OAC, OAC+SAPT, and OAC+DAPT) in
patients undergoing TAVI. The main outcome were all-cause mortality, major
or life-threatening bleeding events, and stroke. RESULT(S): Our
search identified 3 randomized controlled trials and 10 nonrandomized
studies, a total of 20,548 patients who underwent TAVI. All OACs were
vitamin K antagonists. There was no significant difference on mortality
except that OAC+DAPT had significantly higher rates of mortality compared
with others (p < .05, I2 = 0%). SAPT had significantly lower rates of
bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard ratio [HR]:
0.59 [0.46-0.77], p < .001, HR: 0.58 [0.34-0.99], p = .045, HR: 0.41
[0.18-0.93], p = .033, respectively, I2 = 0%). There was no significant
difference on stroke among all antithrombotic strategies.
 CONCLUSION(S): Patients who underwent TAVI had similar all-cause
mortality rates among different antithrombotic strategies except OAC+DAPT.
Patients on SAPT had significantly lower bleeding risk than those on DAPT,
OAC+SAPT, and OAC+DAPT. Our results suggest SAPT is the preferred regimen
when there is no indication for DAPT or OAC. When DAPT or OAC is
indicated, DAPT+OAC should be avoided. Copyright © 2019 Wiley
Periodicals, Inc.

<11>
Accession Number
629573919
Title
Effects of Zoledronate on Cancer, Cardiac Events, and Mortality in
Osteopenic Older Women.
Source
Journal of bone and mineral research : the official journal of the
American Society for Bone and Mineral Research. (no pagination), 2019.
Date of Publication: 11 Oct 2019.
Author
Reid I.R.; Horne A.M.; Mihov B.; Stewart A.; Garratt E.; Bastin S.; Gamble
G.D.
Institution
(Reid, Horne, Mihov, Stewart, Garratt, Gamble) Department of Medicine,
Faculty of Medical and Health Sciences, University of Auckland, Auckland,
New Zealand
(Reid, Bastin) Auckland District Health Board, Auckland, New Zealand
Publisher
NLM (Medline)
Abstract
We recently showed that zoledronate prevented fractures in older women
with osteopenia (hip T-scores between -1.0 and -2.5). In addition to fewer
fractures, this study also suggested that women randomized to zoledronate
had fewer vascular events, a lower incidence of cancer, and a trend to
lower mortality. The present analysis provides a more detailed
presentation of the adverse event data from that study, a 6-year,
double-blind trial of 2000 women aged >65years recruited using electoral
rolls. They were randomly assigned to receive four infusions of either
zoledronate 5mg or normal saline at 18-month intervals. Supplements of
vitamin D, but not calcium, were provided. There were 1017 serious adverse
events in 443 participants in the placebo group, and 820 events in 400
participants in those randomized to zoledronate (relative risk = 0.90; 95%
CI, 0.81 to 1.00). These events included fractures resulting in hospital
admission. Myocardial infarction occurred in 39 women (43 events) in the
placebo group and in 24 women (25 events) in the zoledronate group (hazard
ratio 0.60 [95% CI, 0.36 to 1.00]; rate ratio 0.58 [95% CI, 0.35 to
0.94]). For a prespecified composite cardiovascular endpoint (sudden
death, myocardial infarction, coronary artery revascularization, or
stroke) 69 women had 98 events in the placebo group, and 53 women had 71
events in the zoledronate group (hazard ratio 0.76 [95% CI, 0.53 to 1.08];
rate ratio 0.72 [95% CI, 0.53 to 0.98]). Total cancers were significantly
reduced with zoledronate (hazard ratio 0.67 [95% CI, 0.51 to 0.89]; rate
ratio 0.68 [95% CI, 0.52 to 0.89]), and this was significant for both
breast cancers and for non-breast cancers. Eleven women had recurrent or
second breast cancers during the study, all in the placebo group. The
hazard ratio for death was 0.65 (95% CI, 0.40 to 1.06; p =0.08), and 0.51
(95% CI, 0.30 to 0.87) in those without incident fragility fracture. These
apparent beneficial effects justify further appropriately powered trials
of zoledronate with these nonskeletal conditions as primary endpoints.
© 2019 American Society for Bone and Mineral Research.

<12>
Accession Number
629573852
Title
Use of Pericardium for Cardiac Reconstruction Procedures in Acquired Heart
Diseases-A Comprehensive Review.
Source
The Thoracic and cardiovascular surgeon. (no pagination), 2019. Date of
Publication: 11 Oct 2019.
Author
De Martino A.; Milano A.D.; Bortolotti U.
Institution
(De Martino, Bortolotti) Section of Cardiac Surgery, University Hospital,
Pisa, Italy
(Milano) Department of Cardiac Surgery, University of Bari Aldo Moro,
Bari, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Reconstruction of cardiac structures has been the goal of
many surgeons even before the advent of open-heart procedures with
cardiopulmonary bypass. Unsatisfactory results with synthetic materials
has switched the attention to biological tissues, among which pericardium,
either autologous or of animal origin, has been widely used as patch
material. METHOD(S): We have reviewed the literature to assess the
effective role of pericardial tissue in the correction of various acquired
cardiac lesions. Particularly, special attention was given not only to
established techniques but also to detect any peculiar and unusual
application of pericardium. RESULT(S): Autologous pericardium is
frequently used as patch material particularly when limited valvular
lesions must be corrected, while xenograft pericardium appears
particularly useful in patients with endocarditis and extensive
destruction of the intracardiac structures by infection and abscesses.
Pericardium is an extremely versatile material owing to its pliability and
strength; however, it tends to calcify in the long term when in contact
with blood, although stability of the repair is maintained in most cases.
 CONCLUSION(S): Pericardium plays an important role in various
cardiac and aortic pathologies. Tissues resistant to fibrosis and
calcification to be used as patch material are the ideal solution for more
successful cardiac reconstruction procedures and will hopefully be
provided by the ongoing research. Copyright Georg Thieme Verlag KG
Stuttgart . New York.

<13>
Accession Number
629573659
Title
Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary
Artery Bypass Surgery.
Source
The Thoracic and cardiovascular surgeon. 67 (7) (pp 546-553), 2019. Date
of Publication: 01 Oct 2019.
Author
Velioglu Y.; Isik M.
Institution
(Velioglu) Department of Cardiovascular Surgery, Faculty of Medicine,
Abant Izzet Baysal University, Bolu, Turkey
(Isik) Department of Cardiovascular Surgery, Meram Faculty of Medicine,
Necmettin Erbakan University, Konya, Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: The current study analyzed and compared early-term outcomes
of off-pump versus on-pump beating heart coronary artery bypass surgery.
 METHOD(S): From January 2011 to January 2018, a total of 736
patients underwent isolated first-time elective beating-heart coronary
artery bypass surgery without the use of aortic cross-clamping and
cardioplegic arrest at our institution, and they were included in this
study. Data of patients were collected and retrospectively analyzed.
Patients were divided into two groups according to the use of
cardiopulmonary bypass during the operation, as off-pump group (n=399) and
on-pump beating-heart group (n=337). Both groups were compared with each
other in terms of preoperative, intraoperative, and postoperative data.
 RESULT(S): Groups were statistically similar with regard to baseline
clinical characteristics and demographics. When compared with off-pump
group, on-pump beating-heart group had a greater number of distal bypass,
longer length of hospital stay, and lower postoperative hematocrit level,
and received more blood product transfusion. No statistically significant
differences were detected between the groups with respect to mortality and
postoperative complications except for atrial fibrillation. Atrial
fibrillation was significantly frequent in on-pump beating-heart group.
 CONCLUSION(S): Our study suggested that off-pump and on-pump
beating-heart coronary artery bypass procedures had similar early
mortality and major complication rates except for atrial fibrillation.
However, it seemed that off-pump procedure was superior to on-pump
beating-heart procedure with regard to length of hospital stay, blood
product transfusion, and atrial fibrillation development. Further
prospective randomized studies with larger patient series are needed to
support our research and attain more accurate data. Copyright Georg
Thieme Verlag KG Stuttgart . New York.

<14>
Accession Number
2003185128
Title
Effectiveness of the new generation transcatheter aortic valve in the real
life studies. Review and meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 23 (18) (pp
8018-8027), 2019. Date of Publication: 2019.
Author
Acconcia M.C.; Caretta Q.; Monzo L.; Tanzilli G.; Sili Scavalli A.; Sergi
D.; Di Luozzo M.; Marchei M.; Chiocchi M.; Romeo F.; Gaudio C.
Institution
(Acconcia, Monzo, Tanzilli, Gaudio) Department of Cardiovascular Disease,
Sapienza University of Rome, Rome, Italy
(Caretta) Department of Experimental and Clinical Medicine, University of
Florence, Florence, Italy
(Sili Scavalli) Department of Internal Medicine, Sapienza University of
Rome, Rome, Italy
(Sergi, Di Luozzo, Marchei, Romeo) Department of Cardiovascular Disease,
Tor Vergata University of Rome, Rome, Italy
(Chiocchi) Department of Diagnostic Imaging, Molecular Imaging,
Interventional Radiology and Radiotherapy, Tor Vergata University of Rome,
Rome, Italy
Publisher
Verduci Editore s.r.l (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: The aim of the meta-analysis was to assess post-procedural
outcome of the new generation of transcatheter aortic valve implantation
(TAVI) devices, focusing on thetransfemoral and balloon-expandable SAPIEN
3 (Edwards Lifesciences Inc., Irvine, CA, USA), the self-expanding
CoreValveTM Evolut series R and PRO (R/PRO)TM (Medtronic Inc.,
Minneapolis, MN, USA) and ACURATE neoTM transcatheter aortic valve
(Symetis SA, a Boston Scientific company, Ecublens, Switzerland).
MATERIALS AND METHODS: All observational studies were retrieved through
PubMed computerized database from January 2014 until June 30th,
2019. The risk difference (RD) with the 95% confidence interval (CI) was
used to assess the effectiveness of the intervention under comparison. The
primary end point was 30-day mortality. Safety end points included: (i)
stroke, (ii) moderate/severe paravalvular leak, and (iii) the need for new
permanent pacemaker implantation. RESULT(S): Meta-analysis
demonstrated no significant differences as regards to either 30-day
mortality or stroke for all the groups of prostheses under comparison.
ACURATE neo was associated with significantly less new permanent pacemaker
implantation compared to SAPIEN 3 (RD: -0.06; 95% CI -0.08 to -0.03;
p<0.0001; l2=0%) or to EVOLUT R/PRO (RD: -0.06; 95% CI -0.09 to
-0.02; p=0.0009; l2=0%). A significant reduction of new
permanent pacemaker need was observed in the group of patients implanted
with SAPIEN 3 compared to EVOLUT R/PRO (RD: -0.07; 95% CI -0.09 to -0.04;
p<0.00001; l2=7%). The occurrence of moderate/severe leak was
significantly increased in the group of patients implanted with ACURATE
neo vs. SAPIEN 3 (RD: 0.04; 95% CI 0.02 to 0.05; p<0.00001;
l2=0%). No significant differences were found between ACURATE
neo vs. EVOLUT R/PRO (RD: -0.01; 95% CI -0.04 to 0.02; p=0.69;
l2=0%) and between SAPIEN 3 vs. EVOLUT R/PRO (RD: -0.01; 95% CI
-0.04 to 0.01; p=0.28; l2=73%). CONCLUSION(S): The results
of the meta-analysis show that: (1) ACURATE neo was associated with
significantly less new permanent pacemaker implantation than SAPIEN 3 and
EVOLUT R/PRO; (2) SAPIEN 3 had significantly lower occurrence of
moderate/severe valvular leak than ACURATE neo. Copyright © 2019
Verduci Editore s.r.l. All rights reserved.

<15>
Accession Number
2003300842
Title
Complications Associated with Surgery for Thoracic Disc Herniation: A
Systematic Review and Network Meta-Analysis.
Source
World Neurosurgery. 132 (pp 334-342), 2019. Date of Publication: December
2019.
Author
Brotis A.G.; Tasiou A.; Paterakis K.; Tzerefos C.; Fountas K.N.
Institution
(Brotis, Tasiou, Paterakis, Tzerefos, Fountas) Department of Neurosurgery,
University Hospital of Larissa, Larissa, Thessaly, Greece
(Paterakis, Fountas) Medical School, University of Thessaly, Thessaly,
Greece
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: A systematic review and network meta-analysis (Prospero ID
CRD42018106936) were performed. Objective(s): The selection of the
appropriate surgical approach for the management of thoracic disc
herniation (TDH) is often challenging because of the frequency and
variability of the associated complications. We evaluated the safety of
the surgical approaches for TDH by estimating the mortality (Q1) and
morbidity (Q2), and frequency of the most common complications (Q3).
 Method(s): We searched the medical literature for randomized
controlled trials and observational studies reporting on the management of
TDH. Postoperative complications were the outcome of interest. The
absolute and relative risk estimates, along with the rank probability
scores, were estimated for each approach, through a network meta-analysis.
The results were read in the light of the quality of the available
evidence. Result(s): Fifteen studies with a total of 1036 patients
fulfilled our eligibility criteria. Three deaths were reported. The
overall morbidity was as high as 29%, largely attributed to medical (21%;
95% confidence interval [CI], 10%-38%), surgical site (11%; 95% CI,
5%-22%), cerebrospinal fluid-related (8%; 95% CI, 3%-8%), and neurologic
complications (5%; 95% CI, 1%-24%). The anterior and lateral approaches
were associated with a higher risk for medical and surgical complications
compared with the posterolateral approach. Conclusion(s): Surgery for
TDH is associated with minimal mortality but significant morbidity, with
large variations among the available approaches. An understanding of the
perioperative complications rates is important to develop complication
avoidance strategies and to aid accurate patient-to-doctor
communication. Copyright © 2019 Elsevier Inc.

<16>
Accession Number
2002962476
Title
A Detailed Analysis of Perforations During Chronic Total Occlusion
Angioplasty.
Source
JACC: Cardiovascular Interventions. 12 (19) (pp 1902-1912), 2019. Date of
Publication: 14 October 2019.
Author
Hirai T.; Nicholson W.J.; Sapontis J.; Salisbury A.C.; Marso S.P.;
Lombardi W.; Karmpaliotis D.; Moses J.; Pershad A.; Wyman R.M.; Spaedy A.;
Cook S.; Doshi P.; Federici R.; Nugent K.; Gosch K.L.; Spertus J.A.;
Grantham J.A.
Institution
(Hirai, Salisbury, Nugent, Gosch, Spertus, Grantham) Saint Luke's Mid
America Heart Institute, Kansas City, MO, United States
(Hirai, Salisbury, Spertus, Grantham) Department of Medicine, Division of
Cardiology, University of Missouri Kansas City, Kansas City, Missouri,
United States
(Nicholson) York Hospital, York, PA, United States
(Sapontis) Monash Heart, Melbourne, Australia
(Marso) Research Medical Center, Kansas City, MO, United States
(Lombardi) University of Washington, Seattle, WA, United States
(Karmpaliotis, Moses) Columbia University, New York Presbyterian Hospital,
New York, NY, United States
(Pershad) Banner University Medical Center, Phoenix, AZ, United States
(Wyman) Torrance Medical Center, Torrance, CA, United States
(Spaedy) Boone County Hospital, Columbia, MO, United States
(Cook) Peacehealth Sacred Heart Medical Center, Springfield, OR, United
States
(Doshi) Alexian Brothers Medical Center, Chicago, IL, United States
(Federici) Presbyterian Health System, Albuquerque, New Mexico, Mexico
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to describe the angiographic
characteristics, strategy associated with perforation, and the management
of perforation during chronic total occlusion percutaneous coronary
intervention (CTO PCI). Background(s): The incidence of perforation
is higher during CTO PCI compared with non-CTO PCI and is reportedly
highest among retrograde procedures. Method(s): Among 1,000
consecutive patients who underwent CTO PCI in a 12-center registry, 89
(8.9%) had core lab-adjudicated angiographic perforations. Clinical
perforation was defined as any perforation requiring treatment. Major
adverse cardiac events (MAEs) were defined as in-hospital death, cardiac
tamponade, and pericardial effusion. Result(s): Among the 89
perforations, 43 (48.3%) were clinically significant, and 46 (51.7%) were
simply observed. MAE occurred in 25 (28.0%), and in-hospital death
occurred in 9 (10.1%). Compared with nonclinical perforations, clinical
perforations were larger in size, more often at a collateral location, had
a high-risk shape, and less likely to cause staining or fast filling.
Compared with perforations not associated with MAE, perforations
associated with MAE were larger in size, more proximal or at collateral
location, and had a high-risk shape. When the core lab attributed the
perforation to the approach used when the perforation occurred, 61% of
retrograde perforations by other classifications were actually antegrade.
 Conclusion(s): Larger size, proximal or collateral location, and
high-risk shapes of a coronary perforation were associated with MAE. Six
of 10 perforations occurred with antegrade approaches among patients who
had both strategies attempted. These finding will help emerging CTO
operators understand high-risk features of the perforation that require
treatment and inform future comparisons of retrograde and antegrade
complications. Copyright © 2019 American College of Cardiology
Foundation

<17>
Accession Number
2000795963
Title
Impact of an ultraviolet air sterilizer on cardiac surgery patients, a
randomized clinical trial.
Source
Medicina Clinica. 151 (8) (pp 299-307), 2018. Date of Publication: 23
October 2018.
Author
Heredia-Rodriguez M.; Alvarez-Fuente E.; Bustamante-Munguira J.;
Poves-Alvarez R.; Fierro I.; Gomez-Sanchez E.; Gomez-Pesquera E.;
Lorenzo-Lopez M.; Eiros J.M.; Alvarez F.J.; Tamayo E.
Institution
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez) Department of Anaesthesiology, Hospital
Clinico Universitario, Valladolid, Spain
(Heredia-Rodriguez, Alvarez-Fuente, Poves-Alvarez, Gomez-Sanchez,
Gomez-Pesquera, Lorenzo-Lopez, Tamayo) BioCritic, Group for Biomedical
Research in Critical Care Medicine, Valladolid, Spain
(Bustamante-Munguira) Department of Cardiovascular Surgery, Hospital
Universitario de La Princesa, Madrid, Spain
(Fierro) Department of Health Sciences, European University Miguel de
Cervantes, Valladolid, Spain
(Alvarez, Tamayo) Department of Pharmacology, University of Valladolid,
Valladolid, Spain
(Eiros) Department of Microbiology, Hospital Rio Hortega, Valladolid,
Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Background: Numerous studies have evaluated the use of ultraviolet-C
devices for terminal disinfection in hospitals, however, to date there is
little information about the device's final impact on patients. We
investigated the effect of an ultraviolet air sterilizer (UVAS) on the
clinical outcomes of cardiac surgery patients. Material(s) and
Method(s): This random, prospective and non-interventional study included
1097 adult patients undergoing elective cardiac surgery: 522 stayed in an
ICU room with UVAS (Medixair) and 575 patients ICU room without
UVAS and were used as a control. The primary outcome measure was to
evaluate the effect of a UVAS on the overall prevalence of nosocomial
infections in postoperative cardiac patients in ICUs. Result(s): No
significant differences in ventilator-associated pneumonia (4.6% vs. 5.0%,
p = 0.77) and total infection (14.0% vs. 15.5%, p = 0.45) rates were
detected in patients with and without the UVAS. The length of stay in the
intensive care unit and at the hospital was similar in both groups, UVAS
(4.6 (8.2) days and 18.3 (5.5) days) and without UVAS (4.6 (7.3) days and
19.2 (18.6) days). The 30-day in-hospital mortality rate was 5.3%, no
significant differences between groups were observed (p = 0.053).
 Conclusion(s): Novel ultraviolet-C technology has not been shown to
significantly reduce nosocomial infections or mortality rates in cardiac
surgery patients. Copyright © 2018 Elsevier Espana, S.L.U.

<18>
Accession Number
623816674
Title
Ross Procedure vs Mechanical Aortic Valve Replacement in Adults: A
Systematic Review and Meta-analysis.
Source
JAMA Cardiology. 3 (10) (pp 978-987), 2018. Date of Publication: October
2018.
Author
Mazine A.; Rocha R.V.; El-Hamamsy I.; Ouzounian M.; Yanagawa B.; Bhatt
D.L.; Verma S.; Friedrich J.O.
Institution
(Mazine, Rocha) Division of Cardiac Surgery, Department of Surgery,
University of Toronto, Toronto, ON, Canada
(El-Hamamsy) Department of Cardiac Surgery, Montreal Heart Institute,
Montreal, QC, Canada
(Ouzounian) Department of Cardiac Surgery, Toronto General Hospital,
Toronto, ON, Canada
(Yanagawa, Verma) Department of Cardiac Surgery, St Michael's Hospital,
Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Friedrich) Department of Critical Care Medicine, St Michael's Hospital,
30 Bond St., Toronto, ON M5B 1W8, Canada
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The ideal aortic valve substitute in young and middle-aged
adults remains unknown. Objective(s): To compare long-term outcomes
between the Ross procedure and mechanical aortic valve replacement in
adults. Data Sources: The Ovid versions of MEDLINE and EMBASE classic
(January 1, 1967, to April 26, 2018; search performed on April 27, 2018)
were screened for relevant studies using the following text word search in
the title or abstract: ("Ross" OR "autograft") AND ("aortic" OR
"mechanical"). Study Selection: All randomized clinical trials and
observational studies comparing the Ross procedure to the use of
mechanical prostheses in adults undergoing aortic valve replacement were
included. Studies were included if they reported any of the prespecified
primary or secondary outcomes. Studies were excluded if no clinical
outcomes were reported or if data were published only as an abstract.
Citations were screened in duplicate by 2 of the authors, and
disagreements regarding inclusion were reconciled via consensus. Data
Extraction and Synthesis: This meta-analysis was conducted in accordance
with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology
guidelines. Data were independently abstracted by 3 reviewers and pooled
using a random-effects model. Main Outcomes and Measures: The
prespecified primary outcome was all-cause mortality. Result(s): The
search identified 2919 reports, of which 18 studies (3516 patients) met
inclusion criteria, including 1 randomized clinical trial and 17
observational studies, with a median average follow-up of 5.8
(interquartile range, 3.4-9.2) years. Analysis of the primary outcome
showed a 46% lower all-cause mortality in patients undergoing the Ross
procedure compared with mechanical aortic valve replacement (incidence
rate ratio [IRR], 0.54; 95% CI, 0.35-0.82; P =.004; I2 = 28%).
The Ross procedure was also associated with lower rates of stroke (IRR,
0.26; 95% CI, 0.09-0.80; P =.02; I2 = 8%) and major bleeding
(IRR, 0.17; 95% CI, 0.07-0.40; P <.001; I2 = 0%) but higher
rates of reintervention (IRR, 1.76; 95% CI, 1.16-2.65; P =.007;
I2 = 0%). Conclusions and Relevance: Data from primarily
observational studies suggest that the Ross procedure is associated with
lower all-cause mortality compared with mechanical aortic valve
replacement. These findings highlight the need for a large, prospective
randomized clinical trial comparing long-term outcomes between these 2
interventions. Copyright © 2018 American Medical Association. All
rights reserved.

<19>
Accession Number
628653597
Title
Association between Stress Testing-Induced Myocardial Ischemia and
Clinical Events in Patients with Multivessel Coronary Artery Disease.
Source
JAMA Internal Medicine. 179 (10) (pp 1345-1351), 2019. Date of
Publication: October 2019.
Author
Garzillo C.L.; Hueb W.; Gersh B.; Rezende P.C.; Lima E.G.; Favarato D.;
Franchini Ramires J.A.; Kalil Filho R.
Institution
(Garzillo, Hueb, Rezende, Lima, Favarato, Franchini Ramires, Kalil Filho)
Instituto Do Coracao (InCor), Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Avenida Doutor Eneas de Carvalho
Aguiar 44, AB, Sala 114, Cerqueira Cesar, Sao Paulo 05403-000, Brazil
(Gersh) Department of Medicine, Mayo Clinic College of Medicine,
Rochester, MN, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The long-term prognostic implications of myocardial ischemia
documented during stress testing in patients with multivessel coronary
artery disease (CAD) are unclear. Objective(s): To assess whether
documented stress testing-induced myocardial ischemia is associated with
major adverse cardiovascular events or ventricular function changes in
patients with stable multivessel CAD. Design, Setting, and
Participant(s): A prospective cohort study was conducted using data from a
single-center randomized clinical trial (Medicine, Angioplasty, or Surgery
Study [MASS] II) to examine the association of myocardial ischemia
documented during stress testing at baseline with cardiovascular events
and ventricular function changes during follow-up. Participants were
previously randomized (May 1, 1995, to May 31, 2000) to medical therapy,
percutaneous coronary intervention with bare metal stents, or coronary
artery bypass grafting. Event-free survival was estimated by the
Kaplan-Meier method, and multivariable Cox regression models were
calculated to assess the association between ischemia and the primary
composite end point. The vital status was determined on February 28, 2011.
Data were analyzed from February 1, 2016, to April 1, 2017. Main
Outcomes and Measures: Cardiovascular events (overall mortality,
myocardial infarction, and revascularization for refractory angina) were
tracked from the time of randomization to the end of the 10-year follow-up
(mean [SD] duration, 11.4 [4.3] years). Myocardial ischemia was assessed
at baseline and at 1-year intervals by exercise stress testing, and
ventricular function (left ventricular ejection fraction) was assessed by
echocardiography at baseline and after 10 years. Patients with documented
ischemia were compared with those without ischemia regarding the outcomes
and changes in ventricular function. Result(s): Of 611 participants,
535 underwent exercise stress testing at baseline: 270 with documented
ischemia and 265 without. Of these 535 patients, 373 (69.7%) were men, and
the mean (SD) age for the entire cohort was 59.7 (9.2) years. No
association was found between the presence of ischemia at baseline and
survival free of combined cardiovascular events (hazard ratio, 1.00; 95%
CI, 0.80-1.27; P =.95) after multivariable adjustment that included CAD
initial randomized treatments. In addition, among 320 patients who
underwent echocardiographic evaluation, the slight decline in left
ventricular ejection fraction after 10 years was similar in both groups
(median [SD] difference, -4.9% [18.7%] vs -6.6% [20.0%], respectively, for
groups with and without ischemia; P =.97). Conclusions and Relevance:
In this study, regardless of the therapeutic strategy applied, the
presence of documented myocardial ischemia did not appear to be associated
with an increased occurrence of major adverse cardiovascular events or
changes in ventricular function in patients with multivessel CAD during a
long-term follow-up. Copyright © 2019 American Medical
Association. All rights reserved.

<20>
Accession Number
2002712331
Title
Safety and efficacy of biatrial vs left atrial surgical ablation during
concomitant cardiac surgery: A meta-analysis of clinical studies with a
focus on the causes of pacemaker implantation.
Source
Journal of Cardiovascular Electrophysiology. (no pagination), 2019. Date
of Publication: 2019.
Author
Cappabianca G.; Ferrarese S.; Tutino C.; Corazzari C.; Matteucci M.;
Mantovani V.; Musazzi A.; De Ponti R.; Beghi C.
Institution
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Department of Heart and Vessels, Ospedale di Circolo,
University of Insubria, Varese, Italy
(Cappabianca, Ferrarese, Tutino, Corazzari, Matteucci, Mantovani, Musazzi,
De Ponti, Beghi) Cardiac Surgery Research Center, University of Insubria,
Varese, Italy
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Introduction: The latest STS guidelines recommend concomitant atrial
fibrillation (AF) ablation not only during mitral surgery (Class IA) but
also during other-than-mitral cardiac surgery procedures (Class IB) in
patients with preoperative AF. Conventional Cox-Maze III/IV procedures are
performed on both atria (BA), but several studies reported excellent
results with left atrial only (LA) ablations: the scope of this study is
to compare the safety and efficacy of BA vs LA approach. Methods and
Results: Pubmed, Scopus, and WOS were searched from inception to November
2018: 28 studies including 7065 patients and comparing the performance of
BA vs LA approaches were identified: of these, 16 (57.1%) enrolled
exclusively patients with non-paroxysmal AF forms, 10 (35.7%) focused on
mitral surgery as main procedure, and 16 (57.1%) regarded patients
undergone Cox-Maze with radiofrequency. The 6- and 12-months prevalence of
sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09-1.73, P =.008
and OR, 1.37, CI, 0.99-1.88, P =.05 respectively). Permanent pacemaker
(PPM) implantation (OR, 1.85, CI, 1.38-2.49, P <.0001) and reopening for
bleeding (OR, 1.70, CI, 1.05-2.75, P =.03) were higher in the BA group.
Among patients undergone PPM implantation, BA group had a significantly
higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49-6.07, P
=.002). Conclusion(s): Concomitant BA ablation appears superior to LA
ablation in terms of efficacy but is associated with a higher risk of
bleeding and of PPM implantation, more frequently due to sinoatrial node
dysfunction. LA approach should be preferable in patients with a higher
risk of bleeding or with perioperative risk factors for PPM
implantation. Copyright © 2019 Wiley Periodicals, Inc.

<21>
Accession Number
2003283159
Title
Preoperative Risk Assessment and Management in Adults Receiving
Maintenance Dialysis and Those With Earlier Stages of CKD.
Source
American Journal of Kidney Diseases. (no pagination), 2019. Date of
Publication: 2019.
Author
Bahrainwala J.Z.; Gelfand S.L.; Shah A.; Abramovitz B.; Hoffman B.;
Leonberg-Yoo A.K.
Institution
(Bahrainwala, Gelfand, Hoffman, Leonberg-Yoo) Renal-Electrolyte and
Hypertension Division, Department of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Shah) Division of Kidney Disease & Hypertension, Department of Medicine,
Brown University, Providence, RI, United States
(Shah) Division of Nephrology, Medical Service, Providence Veterans
Affairs Medical Center, Providence, RI, United States
(Abramovitz) Division of Renal-Electrolyte, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
Publisher
W.B. Saunders
Abstract
With an increasingly aging population and improved mortality in
individuals with end-stage kidney disease, more surgeries are being
performed on patients with all stages of chronic kidney disease (CKD).
This high-risk population carries unique risk factors that have been
associated with increased adverse perioperative outcomes, including acute
kidney injury, cardiovascular events, and mortality. In this article, we
review the literature describing absolute risks associated with common
surgeries performed in patients with CKD and patients receiving
maintenance dialysis. We also review perioperative optimization with
special risk assessment including evaluation of cardiovascular and
bleeding risk evaluation, hypertension management, and timing of dialysis.
Predictive model scores are reviewed as a method to stratify risk for
acute kidney injury, major adverse cardiac events, or other serious
complications with elective surgeries. A multidisciplinary approach with
individualized counseling is necessary to counsel the patient with
advanced CKD or patients treated with maintenance dialysis considering
elective surgery. Copyright © 2019 National Kidney Foundation,
Inc.

<22>
Accession Number
628648898
Title
The use of mannitol in cardiopulmonary bypass prime solution-Prospective
randomized double-blind clinical trial.
Source
Acta anaesthesiologica Scandinavica. 63 (10) (pp 1298-1305), 2019. Date of
Publication: 01 Nov 2019.
Author
Ljunggren M.; Skold A.; Dardashti A.; Hyllen S.
Institution
(Ljunggren, Skold, Dardashti, Hyllen) Department of Cardiothoracic
Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund,
Sweden
(Dardashti, Hyllen) Department of Clinical Sciences, Cardiothoracic
Surgery, Lund University, Lund, Sweden
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal prime solution for the cardiopulmonary bypass
(CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol
is widely used in the priming solution for CPB despite the fact that there
is no clear consensus on the role of mannitol in cardiac surgery. The aim
of this study was to investigate the effect of mannitol in the CPB prime
solution. METHOD(S): This prospective, randomized, double-blind study
included 40 patients with normal cardiac and renal functions, who
underwent coronary artery bypass grafting. One group received a prime
based on Ringer's acetate (n = 20), and the other a prime consisting of
Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality,
acid-base status, electrolytes, and renal-related parameters were
monitored. RESULT(S): No significant differences were found in
osmolality between the Ringer's acetate group and the mannitol group at
any time. The mannitol group showed a pronounced decrease in sodium, from
138.7 +/- 2.8 mmol/L at anaesthesia onset, to 133.9 +/- 2.6 mmol/L after
the start of CPB (P < .001). No differences were seen in the renal
parameters between the groups, apart from a short-term effect of mannitol
on peroperative urine production (P = .003). CONCLUSION(S): We
observed no effects on osmolality of a prime solution containing mannitol
compared to Ringer's acetate-based prime in patients with normal cardiac
and renal function. The use of mannitol in the prime resulted in a
short-term, significant decrease in sodium level. Copyright ©
2019 The Authors. Acta Anaesthesiologica Scandinavica published by John
Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica
Foundation.

<23>
Accession Number
629371775
Title
Low-dose anticoagulation after isolated mechanical aortic valve
replacement with Liva Nova Bicarbon prosthesis: A post hoc analysis of
LOWERING-IT Trial.
Source
Scientific reports. 8 (1) (pp 8405), 2018. Date of Publication: 30 May
2018.
Author
Torella M.; Aquila I.; Chiodini P.; Amarelli C.; Romano G.; Della Ratta
E.E.; De Feo M.; Della Corte A.; Indolfi C.; Torella D.; De Santo L.S.
Institution
(Torella, Della Ratta, De Feo, Della Corte) Department of Cardio-Thoracic
Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
(Aquila, Indolfi, Torella) Cardiovascular Institute, Department of Medical
and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
(Chiodini) Department of Medicine and Public Health, University of
Campania "Luigi Vanvitelli", Naples, Italy
(Amarelli, Romano) Department of Cardiovascular Surgery and Transplants,
V. Monaldi Hospital, Naples, Italy
(De Santo) Department of Medical and Surgical Sciences, Chair of Cardiac
Surgery, University of Foggia, Foggia, Italy
(De Santo) Casa di Cura Montevergine, GVM, Care & Research, Avellino,
Italy
Publisher
NLM (Medline)
Abstract
Thromboembolic complications after cardiac valve replacement are due to a
complex interplay between patients' characteristics, device features and
anticoagulation intensity. Subtle design and material differences in
available prostheses may thrombosis. We conducted a post-hoc sub-analysis
of the LOWERING-IT database to test the safety and feasibility of a
low-level oral anticoagulant regime in low-risk patients with aortic
LivaNova prosthetic valve replacement. The study population included 148
patients randomized to a low INR target (1.5-2.5; LOW-INR group), and 144
patients to the standard INR (2.0-3.0; CONVENTIONAL-INR group). The
non-inferiority of thromboembolic events between LOW-INR and
CONVENTIONAL-INR groups was tested. Cumulative follow-up reached 1,545
patient/years. The mean INR was 1.91+/-0.23 in the LOW-INR group, and
2.59+/-0.26 in the CONVENTIONAL-INR group (P<0.001). There were 3
thromboembolic events, all in the CONVENTIONAL-INR group. Comparison of
thromboembolic events was not significant. The 1-sided 97.5% exact CI for
the difference in primary event proportion was 0.54%, satisfying criteria
non-inferiority. Bleeding events were significantly different: 6.61 per
1,000 patient-year in LOW-INR group vs 18.65 per 1,000 patient-year in
CONVENTIONAL-INR group (p<0.045, RR 0.37). In conclusions these data
suggest that low-dose anticoagulation is safe in selected patients after
aortic LivaNova Bicarbon prosthesis implantation.

<24>
Accession Number
629568592
Title
Impact of Prosthesis-Patient Mismatch on Survival after Mitral Valve
Replacement: A Meta-analysis.
Source
The Thoracic and cardiovascular surgeon. 67 (7) (pp 538-545), 2019. Date
of Publication: 01 Oct 2019.
Author
Hwang H.-Y.; Sohn S.-H.; Jang M.-J.
Institution
(Hwang, Sohn, Jang) Department of Thoracic and Cardiovascular Surgery,
Seoul National University Hospital, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Numerous studies have demonstrated a negative impact of
prosthesis-patient mismatch (PPM) on long-term clinical outcomes after
aortic valve replacement. However, the impact of PPM after mitral valve
replacement (MVR) on clinical outcomes is still controversial. This study
was conducted to evaluate the impact of PPM on early and long-term
survival after MVR. METHOD(S): A literature search of five databases
was performed. The primary and secondary outcomes were all-cause mortality
and early mortality, respectively. Subgroup analyses were performed
according to the risk of bias, patients' age, proportion of female
patients, and proportion of patients with mechanical MVR. RESULT(S):
Eleven nonrandomized studies including 8,072 patients were included in
this meta-analysis. The overall incidence of PPM was 58.0% (range:
10.4-85.9%). The odds ratio of early mortality in nine studies was not
significantly different between the PPM and non-PPM patients (odds ratio:
1.35; 95% confidence interval [CI]: 0.98-1.86). A pooled analysis in 11
studies demonstrated that all-cause mortality after MVR was higher in the
PPM than non-PPM patients (hazard ratio [HR]: 1.39; 95% CI: 1.09-1.77).
This analysis revealed a moderate to high heterogeneity (I2=69.4%). When
pooled analyses were performed in two subgroups according to the
proportion of patients with mechanical MVR, there were low heterogeneity
in each group. No other subgroup analyses demonstrated a significant
difference in the HR of all-cause mortality. Funnel plots and Egger's
tests showed no visually and statistically significant publication bias.
 CONCLUSION(S): The present meta-analysis indicates that PPM
negatively affects long-term survival after MVR. Copyright Georg
Thieme Verlag KG Stuttgart . New York.

<25>
Accession Number
629568499
Title
Is There a Place for Thoracoscopic Enucleation of Esophageal
Gastrointestinal Stromal Tumors?.
Source
The Thoracic and cardiovascular surgeon. 67 (7) (pp 585-588), 2019. Date
of Publication: 01 Oct 2019.
Author
Cohen C.; Pop D.; Icard P.; Berthet J.-P.; Venissac N.; Mouroux J.
Institution
(Cohen, Pop, Icard, Berthet, Venissac, Mouroux) Department of Thoracic
Surgery, Centre Hospitalier Universitaire de Nice, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Esophageal gastrointestinal stromal tumors (E-GISTs)
represent less than 1% of all GISTs. The rarity of this lesion precludes
the realization of randomized studies, and its treatment remains a matter
of debate. We aimed to evaluate the feasibility of enucleation by
video-assisted thoracic surgery (VATS) for low- to intermediate-risk
E-GIST. METHOD(S): We performed a retrospective review of patients
treated by enucleation through VATS between January 2004 and January 2014
and reviewed the literature. RESULT(S): We included five patients
(four men and one woman). Mean age was 53 years (range: 49-79). Three
patients were diagnosed because of dysphagia and two others incidentally.
The diagnosis was made by immunostaining demonstrating CD117 expression on
tumor cells. The mitotic index of all E-GISTs was low (<= 5 per 50
high-power field). Median postoperative follow-up was 5.5 years, and there
was no recurrence. CONCLUSION(S): Thoracoscopic enucleation of
E-GIST seems to represent a valuable option as the postoperative
morbidity/mortality is low and the oncological outcome is good for
low-to-intermediate grade of malignity tumors.This is a retrospective
study focused on minimally invasive treatment of E-GIST. We evaluated the
feasibility of VATS enucleation of low-to-medium grade of malignity
E-GIST. Copyright Georg Thieme Verlag KG Stuttgart . New York.

<26>
Accession Number
629565951
Title
The use of a machine-learning algorithm that predicts hypotension during
surgery in combination with personalized treatment guidance: study
protocol for a randomized clinical trial.
Source
Trials. 20 (1) (pp 582), 2019. Date of Publication: 11 Oct 2019.
Author
Wijnberge M.; Schenk J.; Terwindt L.E.; Mulder M.P.; Hollmann M.W.; Vlaar
A.P.; Veelo D.P.; Geerts B.F.
Institution
(Wijnberge, Schenk, Terwindt, Mulder, Hollmann, Veelo, Geerts) Department
of Anesthesiology, location Academic Medical Center, University of
Amsterdam, Meibergdreef 9 ,Postbus 22660, Amsterdam 1105 AZ, Netherlands
(Wijnberge, Vlaar) Department of Intensive Care Medicine, location
Academic Medical Center, University of Amsterdam, Meibergdreef 9 ,Postbus
22660, Amsterdam 1105 AZ, Netherlands
(Mulder) Department of Technical Medicine, University of Twente,
Drienerlolaan 5, Enschede 7522 NB, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative hypotension is associated with increased
morbidity and mortality. Current treatment is mostly reactive. The
Hypotension Prediction Index (HPI) algorithm is able to predict
hypotension minutes before the blood pressure actually decreases. Internal
and external validation of this algorithm has shown good sensitivity and
specificity. We hypothesize that the use of this algorithm in combination
with a personalized treatment protocol will reduce the time weighted
average (TWA) in hypotension during surgery spent in hypotension
intraoperatively. METHODS/DESIGN: We aim to include 100 adult patients
undergoing non-cardiac surgery with an anticipated duration of more than
2h, necessitating the use of an arterial line, and an intraoperatively
targeted mean arterial pressure (MAP) of >65mmHg. This study is divided
into two parts; in phase A baseline TWA data from 40 patients will be
collected prospectively. A device (HemoSphere) with HPI software will be
connected but fully covered. Phase B is designed as a single-center,
randomized controlled trial were 60 patients will be randomized with
computer-generated blocks of four, six or eight, with an allocation ratio
of 1:1. In the intervention arm the HemoSphere with HPI will be used to
guide treatment; in the control arm the HemoSphere with HPI software will
be connected but fully covered. The primary outcome is the TWA in
hypotension during surgery. DISCUSSION: The aim of this trial is to
explore whether the use of a machine-learning algorithm intraoperatively
can result in less hypotension. To test this, the treating
anesthesiologist will need to change treatment behavior from reactive to
proactive. TRIAL REGISTRATION: This trial has been registered with the
NIH, U.S. National Library of Medicine at ClinicalTrials.gov, ID:
NCT03376347 . The trial was submitted on 4 November 2017 and accepted for
registration on 18 December 2017.

<27>
Accession Number
629565892
Title
Serum albumin in patients undergoing transcatheter aortic valve
replacement: A meta-analysis.
Source
Reviews in cardiovascular medicine. 20 (3) (pp 161-169), 2019. Date of
Publication: 30 Sep 2019.
Author
Hsieh W.C.; Aboud A.; Henry B.M.; Omara M.; Lindner J.; Pirk J.
Institution
(Hsieh) First Faculty of Medicine, Charles University, Prague 1200,
Czechia
(Hsieh, Lindner) 22nd Department of Cardiovascular Surgery, First Faculty
of Medicine, Charles University and General University Hospital in Prague,
Prague 1200, Czechia
(Aboud) Department of Cardiac and Thoracic Vascular Surgery, University of
Schleswig-Holstein, Lubeck Campus, Lubeck 23562, Germany
(Henry) Division of Cardiology, Cincinnati Children's Hospital Medical
Center, Cincinnati, OH 45229, United States
(Omara) Department of Thoracic and Cardiovascular Surgery, Research
Institute, Cleveland Clinic, Cleveland, OH 44195, United States
(Pirk) Department of Cardiology and Cardiac Surgery, Institute of Clinical
and Experimental Medicine IKEM, Prague 14021, Czechia
Publisher
NLM (Medline)
Abstract
Transcatheter aortic valve replacement is becoming a more common
therapeutic option for the treatment of aortic stenosis in patients at
high risk for invasive surgery, but detecting which patients will benefit
clinically can be challenging. Hypoalbuminemia is a useful prognostic
marker for chronic inflammation in this population. We carried out a
systematic review and meta-analysis of studies evaluating the prognostic
value of serum albumin level in patients undergoing transcatheter aortic
valve replacement. A literature search of PubMed, Embase, ScienceDirect,
Web of Science, SciELO, BIOSIS, Wanfang, and CNKI databases was conducted.
Articles published between January 2000 and December 2017 reporting on the
prognostic value of low levels of serum albumin in patients undergoing
transcatheter aortic valve replacement were analyzed according to
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. 11 studies including 6456 patients met inclusion criteria for
meta-analysis. A lower serum albumin level was associated with a lower
survival rate at follow-up in patients who underwent transcatheter aortic
valve replacement. A sub-group analysis of eight studies reporting
adjusted hazard ratios indicated that low serum albumin was independently
correlated with increased post-operative mortality. The hazard ratio of
mortality risk associated with each 1 g/dL increment in serum albumin
level was 0.46, suggesting a potential dose-response relationship between
increased serum albumin level and increased survival rate in patients
undergoing transcatheter aortic valve replacement. This meta-analysis
provides strong evidence for the utility of serum albumin as a prognostic
marker in aortic stenosis patients undergoing transcatheter aortic valve
replacement, with low serum albumin levels (2.5-3.5 g/dL) suggesting poor
prognosis. Copyright © 2019 Hsieh et al. Published by IMR press.
All rights reserved.

<28>
Accession Number
629565657
Title
Antithrombotic treatment after coronary artery bypass graft surgery:
systematic review and network meta-analysis.
Source
BMJ (Clinical research ed.). 367 (pp l5476), 2019. Date of Publication: 10
Oct 2019.
Author
Solo K.; Lavi S.; Kabali C.; Levine G.N.; Kulik A.; John-Baptiste A.A.;
Fremes S.E.; Martin J.; Eikelboom J.W.; Ruel M.; Huitema A.A.; Choudhury
T.; Bhatt D.L.; Tzemos N.; Mamas M.A.; Bagur R.
Institution
(Solo, John-Baptiste, Martin, Bagur) Department of Epidemiology and
Biostatistics, Schulich School of Medicine & Dentistry, Western
University, ON, London, Canada
(Solo) Cochrane Canada Center, MacGRADE Center and Department of Health
Research Methods, McMaster University, ON, Hamilton, Canada
(Lavi, Huitema, Choudhury, Tzemos, Bagur) London Health Sciences Centre,
Division of Cardiology, Department of Medicine, Schulich School of
Medicine & Dentistry, Western University, ON, London, Canada
(Kabali) Epidemiology Division, Dalla Lana School of Public Health,
University of Toronto, ON, Toronto, Canada
(Levine) Department of Medicine, Baylor College of Medicine, TX, Houston,
United States
(Kulik) Lynn Heart and Vascular Institute, Charles E. Schmidt College of
Medicine, Florida Atlantic University, FL, Boca Raton Regional Hospital,
Boca Raton, United States
(John-Baptiste, Martin) Department of Anesthesia & Perioperative Medicine
and Centre for Medical Evidence, Decision Integrity & Clinical Impact
(MEDICI), Western University, ON, London, Canada
(John-Baptiste) Interfaculty Program in Public Health, Western University,
ON, London, Canada
(Fremes) Schulich Heart Centre, Sunnybrook Health Science, University of
Toronto, ON, Toronto, Canada
(Fremes) Institute of Health Policy, Management and Evaluation, Dalla Lana
School of Public Health, University of Toronto, ON, Canada
(Eikelboom) Population Health Research Institute, McMaster University and
Hamilton Health Sciences, ON, Hamilton, Canada
(Ruel) University of Ottawa Heart Institute, ON, Ottawa, Canada
(Bhatt) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard Medical School, MA, Boston, United
States
(Mamas, Bagur) Keele Cardiovascular Research Group, Institute for Applied
Clinical Science and Centre for Prognosis Research, Institute of Primary
Care and Health Sciences, Keele University, Stoke on Trent, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To assess the effects of different oral antithrombotic drugs
that prevent saphenous vein graft failure in patients undergoing coronary
artery bypass graft surgery. DESIGN: Systematic review and network
meta-analysis. DATA SOURCES: Medline, Embase, Web of Science, CINAHL, and
the Cochrane Library from inception to 25 January 2019. ELIGIBILITY
CRITERIA: for selecting studies Randomised controlled trials of
participants (aged >=18) who received oral antithrombotic drugs
(antiplatelets or anticoagulants) to prevent saphenous vein graft failure
after coronary artery bypass graft surgery. MAIN OUTCOME MEASURES: The
primary efficacy endpoint was saphenous vein graft failure and the primary
safety endpoint was major bleeding. Secondary endpoints were myocardial
infarction and death. RESULT(S): This review identified 3266
citations, and 21 articles that related to 20 randomised controlled trials
were included in the network meta-analysis. These 20 trials comprised 4803
participants and investigated nine different interventions (eight active
and one placebo). Moderate certainty evidence supports the use of dual
antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50,
95% confidence interval 0.31 to 0.79, number needed to treat 10) or
aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein
graft failure when compared with aspirin monotherapy. The study found no
strong evidence of differences in major bleeding, myocardial infarction,
and death among different antithrombotic therapies. The possibility of
intransitivity could not be ruled out; however, between-trial
heterogeneity and incoherence were low in all included analyses.
Sensitivity analysis using per graft data did not change the effect
estimates. CONCLUSION(S): The results of this network meta-analysis
suggest an important absolute benefit of adding ticagrelor or clopidogrel
to aspirin to prevent saphenous vein graft failure after coronary artery
bypass graft surgery. Dual antiplatelet therapy after surgery should be
tailored to the patient by balancing the safety and efficacy profile of
the drug intervention against important patient outcomes. STUDY
REGISTRATION: PROSPERO registration number CRD42017065678. Copyright
Published by the BMJ Publishing Group Limited. For permission to use
(where not already granted under a licence) please go to
http://group.bmj.com/group/rights-licensing/permissions.

<29>
[Use Link to view the full text]
Accession Number
629560756
Title
Electrical Stimulation of the Greater Auricular Nerve to Reduce
Postoperative Atrial Fibrillation.
Source
Circulation. Arrhythmia and electrophysiology. 12 (10) (pp e007711), 2019.
Date of Publication: 01 Oct 2019.
Author
Andreas M.; Arzl P.; Mitterbauer A.; Ballarini N.M.; Kainz F.-M.; Kocher
A.; Laufer G.; Wolzt M.
Institution
(Andreas, Arzl, Mitterbauer, Kainz, Kocher, Laufer) Department of Cardiac
Surgery (M.A., Medical University of Vienna, A.M., Austria
(Ballarini) Center for Medical Statistics, Informatics, Intelligence
Systems (CeMSIIS) (N.M.B.), Medical University of Vienna, Austria
(Wolzt) Section for Medical Statistics, Department of Clinical
Pharmacology (M.W.), Medical University of Vienna, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) occurs in up to 40%
of patients undergoing cardiac surgery. Invasive stimulation of the vagal
nerve previously demonstrated a reduced risk of POAF. Therefore, we
examined the antiarrhythmic and anti-inflammatory effects of noninvasive
low-level transcutaneous electrical stimulation (LLTS) of the greater
auricular nerve in a pilot trial including patients undergoing cardiac
surgery. METHOD(S): Patients were randomized into a sham (n=20) or a
treatment group (n=20) for LLTS. After cardiac surgery, electrodes were
applied in the triangular fossa of the ear. Stimulation (amplitude 1 mA,
frequency 1 Hz for 40 minutes, followed by a 20 minutes break) was
performed for up to 2 weeks after cardiac surgery. Heart rhythm was
recorded continuously using an ECG during the observation period. CRP
(C-reactive protein) and IL (interleukin)-6 plasma concentrations were
measured immediately after surgery as well as on day 2 and 7 postsurgery.
 RESULT(S): Patients receiving LLTS had a significantly reduced
occurrence of POAF (4 of 20) when compared with controls (11 of 20,
P=0.022) during a similar mean Holter recording period. The median
duration of POAF was comparable between the treatment and the control
group (878 [249; 1660] minutes versus 489 [148; 1775] minutes; P=0.661).
No effect of LLTS on CRP or IL-6 levels was detectable.
 CONCLUSION(S): LLTS of the greater auricular nerve may be a potential
therapy for POAF. We demonstrated the feasibility to conduct a randomized
trial of neurostimulation as an outlay for a multisite clinical trial.

<30>
Accession Number
629559966
Title
An An Open-Label, Single Center, Retrospective Study to Evaluate Clinical
Outcomes with Surgical Sealant in Bentall Procedures: A Cohort Study.
Source
The heart surgery forum. 22 (5) (pp E396-E400), 2019. Date of Publication:
24 Sep 2019.
Author
Gu J.; Lai H.; Li J.; Sun Y.; Liu C.; Wang Y.; Zhang Z.; Kang L.; Huang
B.; Wang C.
Institution
(Gu) Zhongshan hospital affiliated to Fudan University, No. 180, Fenglin
Road ,Xuhui District, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiovascular surgery is associated with substantial risk for
postoperative bleeding with increased patient morbidity and mortality.
Numerous intraoperative techniques have been utilized to reduce this risk.
This study was to assess postoperative bleeding-related parameters
following Bentall procedures and to examine the impact of intraoperative
surgical sealant application. METHOD(S): The medical/surgical records
of 100 consecutive Bentall procedure cases were examined retrospectively
for perioperative surgical sealant use and postoperative bleeding-related
outcomes. RESULT(S): Of the 100 patient cases, three died during the
postoperative period, and 97 were evaluable. Surgical sealant was utilized
in 56 patient cases (57.8%). The utilization versus no utilization of
surgical sealant was associated with significant reductions in most
postoperative bleeding-related parameters, including less drainage (P =
.028), resternotomy for hemorrhage (P = .036), transfusion of red blood
cells (P = .022 at 48 hours; P = .027 total in-hospital), transfusion of
fresh frozen plasma (P = .04 at 48 hours; P = .004 total in-hospital), and
a higher percentage of cases not needing blood transfusion (P = .002). The
surgical sealant group had longer cardiopulmonary bypass circuit (P =
.016) and aortic cross-clamp time (P = .001), with no significant
between-group differences in intubation time (P = .636) or intensive care
unit duration (P = .294). When excluding urgent cases or Stanford type A
aortic dissections, intensive care unit duration significantly was shorter
in the surgical sealant group (P = .017). Surgical sealant use was not
associated with any adverse events. CONCLUSION(S): The application of
surgical sealant to the anastomosis suture line in Bentall procedures
reduces postoperative drainage, bleeding, and transfusion utilization.
Further studies are warranted to investigate these benefits in
prospective, randomized clinical trials.

<31>
Accession Number
629559867
Title
Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste
Functions.
Source
The heart surgery forum. 22 (5) (pp E416-E422), 2019. Date of Publication:
01 Oct 2019.
Author
Erdem K.; Ucaroglu E.R.; Sehitogullari A.; Yuksel A.; Tekce H.; Velioglu
Y.; Demirhan A.; Korkmaz U.T.K.; Borulu F.; Unal O.; Ulku A.; Calisir E.
Institution
(Erdem) Department of Cardiovascular Surgery, Faculty of Medicine, Bolu
Abant Izzet Baysal University, Bolu, Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: Olfactory and taste sensations have a high impact on the
quality of life. Impaired olfactory and taste functions may have a
negative effect on physical and mental well-being, personal hygiene, and
nutritional satisfaction, leading to the occurrence of depressive symptoms
and impaired quality of life. Therefore, the recovery period of patients
with disturbed olfactory and taste functions may be prolonged, and return
to active life may be delayed. We designed this study to determine whether
on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have
any effects on olfactory and taste functions and compare these functions
between the surgical groups. METHOD(S): A total of 60 patients, who
underwent elective isolated first-time CABG, were included in this study.
Patients were divided into two groups as Off-Pump and On-Pump CABG groups
with 30 patients in each group. In addition to patients' primary clinical
and laboratory data, olfactory and taste functions were evaluated pre- and
postoperatively in both groups separately, and then these functions were
compared between the groups. Olfactory functions were evaluated by the
Brief Smell Identification Test, while taste functions by the Burghart
Taste test. RESULT(S): Olfactory functions significantly were
disrupted in the postoperative period in patients undergoing on-pump CABG
(P value < .05), while these functions significantly were not affected in
patients undergoing off-pump CABG (P value > .05). During the preoperative
period, advanced age and smoking were detected to be independent
predictors of impaired olfactory function for the study population. During
the postoperative period, smoking, amount of postoperative bleeding and
serum low-density lipoprotein (LDL) level were found to be independent
predictors of impaired olfactory function for just the On-Pump CABG Group.
In both groups, no significant deterioration in taste functions occurred
during the postoperative period (P value > .05). CONCLUSION(S): Our
study demonstrated that olfactory function was impaired in patients, who
underwent on-pump CABG in the postoperative period, and significant
impairment in taste function was present in neither off-pump nor on-pump
CABG patients. However, the results of our study should be supported by
more comprehensive, prospective, randomized controlled trials with more
extensive patient series and by further tests.

<32>
[Use Link to view the full text]
Accession Number
628358044
Title
Baseline significant tricuspid regurgitation is associated with higher
mortality in transcatheter aortic valve replacement: Systemic review and
meta-analysis.
Source
Journal of Cardiovascular Medicine. 20 (7) (pp 477-486), 2019. Date of
Publication: July 2019.
Author
Prasitlumkum N.; Kittipibul V.; Tokavanich N.; Kewcharoen J.; Rattanawong
P.; Angsubhakorn N.; Mao M.A.; Gillaspie E.A.; Cheungpasitporn W.
Institution
(Prasitlumkum, Kewcharoen, Rattanawong) Department of Internal Medicine,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI,
United States
(Kittipibul) Department of Internal Medicine, Jackson Memorial Hospital
Internal Medicine Residency Program, Miami, FL, United States
(Tokavanich) Department of Cardiology, Chulalongkorn University, Bangkok,
Thailand
(Rattanawong) Faculty of Medicine Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
(Angsubhakorn) Department of Medicine, University of Minnesota,
Minneapolis, United States
(Mao) Division of Internal Medicine, Mayo Clinic, Rochester, MN, United
States
(Gillaspie) Department of Thoracic Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Cheungpasitporn) Department of Medicine, University of Mississippi
Medical Center, Jackson, MS, United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Introduction Significant tricuspid regurgitation is a well recognized
indicator of right ventricular dysfunction. Recent studies have shown that
significant tricuspid regurgitation is potentially associated with
increased mortality in patients with severe aortic stenosis who underwent
transcatheter aortic valve replacement (TAVR). However, data remained
sparse and inconclusive. Thus, we performed a systematic review and
meta-analysis of the literature to assess the association between
significant tricuspid regurgitation and mortality in post TAVR patients.
Hypothesis Significant tricuspid regurgitation is predictive for higher
mortality in patients undergoing TAVR. Methods We comprehensively searched
the databases of MEDLINE and EMBASE from inception to October 2018.
Included studies were published observational studies that reported
multivariate analysis of the effects of significant tricuspid
regurgitation on all-cause mortality among patients undergoing TAVR. Data
from each study were combined utilizing the random-effects, generic
inverse variance method of DerSimonian and Laird to calculate odds ratios
(ORs) and 95% confidence intervals (CIs). Results Nine cohort studies from
August 2011 to May 2018 consisting of 27 614 patients with severe aortic
stenosis undergoing TAVR (6255 with and 21 359 without significant
tricuspid regurgitation) were included in this meta-analysis. The presence
of significant tricuspid regurgitation was associated with higher
all-cause mortality (pooled OR = 2.26, 95% CI: 1.45 - 3.52, P < 0.001). We
found that all-cause mortality remained statistically substantial in all
subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20 - 3.49, P =
0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44 - 38.31, P =
0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19 - 1.85,
P < 0.001). Funnel plots and Egger's regression asymmetry test were
performed and showed no publication bias. Conclusion Significant tricuspid
regurgitation increased risk of mortality by up to two-fold among patients
with severe aortic stenosis undergoing TAVR. Our study suggests that
significant tricuspid regurgitation should be considered a component of
risk stratification tools. Copyright © 2019 Italian Federation of
Cardiology - I.F.C. All rights reserved.

<33>
Accession Number
626725484
Title
Myocardial protection and clinical outcomes in Tetralogy of Fallot
patients undergoing intracardiac repair: a randomized study of two
cardioplegic techniques.
Source
Perfusion (United Kingdom). 34 (6) (pp 495-502), 2019. Date of
Publication: 01 Sep 2019.
Author
Negi S.L.; Mandal B.; Singh R.S.; Puri G.D.
Institution
(Negi, Mandal, Puri) Department of Anaesthesia and Intensive Care,
Postgraduate Institute of Medical Education and Research, Chandigarh,
India
(Singh) Department of Cardiothoracic and Vascular Surgery, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Myocardial protection in Tetralogy of Fallot patients
undergoing intracardiac repair is suboptimal due to hypertrophied right
ventricle. Hypertrophied myocardium is more susceptible to poor myocardial
preservation because of inadequate capillary density as compared to the
myocytes. There is a capillary to myocyte ratio mismatch. But del Nido
Cardioplegia owing to its less viscosity is able to get more evenly
distributed under hypothermic cardiopulmonary bypass as opposed to blood
Cardioplegia. We hypothesized that the del Nido Cardioplegia technique,
would be beneficial in myocardial protection because of its composition
and method of delivery, leading into better early and late clinical
outcomes in patients undergoing Tetralogy of Fallot repair as compared to
blood cardioplegia reconstituted using St Thomas Cardioplegia solution.
The objective of the study was to identify a better technique of
myocardial preservation in Tetralogy of Fallot patient. Method(s): In
total, 56 Tetralogy of Fallot patients undergoing intracardiac repair
under mild hypothermic cardiopulmonary bypass were randomly allocated to
receive antegrade Cardioplegia with either standard blood Cardioplegia
(Group I) or del Nido Cardioplegia (Group II). Preoperative as well as
postoperative data including echocardiographic parameters for right
ventricle functions, creatine kinase MB level, inotropic requirement,
mechanical ventilation duration, intensive care unit stay and hospital
mortality were evaluated. Result(s): Inotropic score in the first 24
hours postoperatively was significantly lower in Group II compared to
Group I (13.4 +/- 7.2 vs. 21.2 +/- 9.6, p = 0.003). Creatine kinase MB
level (ng/mL) was comparable between the groups. Echocardiographic
parameters for right ventricle functions were also comparable between the
groups during early as well as after 3 to 6 months postoperatively.
 Conclusion(s): Del Nido Cardioplegia is equally efficacious in
providing myocardial protection during intracardiac repair under mild
hypothermic cardiopulmonary bypass in Tetralogy of Fallot patients as
compared to blood Cardioplegia solution with the added benefit of reducing
inotropic requirement in first 24 hours postoperative
period. Copyright © The Author(s) 2019.

<34>
Accession Number
2002379732
Title
Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A
systematic review and meta-analysis comparison among conventional,
stentless, rapid-deployment, and transcatheter valves.
Source
International Journal of Cardiology. 296 (pp 43-50), 2019. Date of
Publication: 1 December 2019.
Author
Jiritano F.; Santarpino G.; Serraino G.F.; Ten Cate H.; Matteucci M.; Fina
D.; Mastroroberto P.; Lorusso R.
Institution
(Jiritano, Matteucci, Fina, Lorusso) Cardio-Thoracic Surgery Dept., Heart
& Vascular Centre, Maastricht University Medical Centre, and
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Jiritano, Serraino, Mastroroberto) Cardiac Surgery Unit, University
"Magna Graecia" of Catanzaro, Catanzaro, Italy
(Santarpino) Citta di Lecce Hospital, GVM Care & Research, Lecce, Italy
(Ten Cate) Laboratory for Clinical Thrombosis and Hemostasis, Department
of Internal Medicine, Cardiovascular Research Institute Maastricht
(CARIM), Maastricht University Medical Center, Maastricht, Netherlands
(Matteucci) Department of Cardiac Surgery, Circolo Hospital, University of
Insubria, Varese, Italy
(Fina) University of Milan, IRCCS San Donato, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: Thrombocytopenia has been shown to occur soon after surgical
biological aortic valve replacement (AVR), and recently reported also
after transcatheter valve implantation (TAVI). The mechanism underlying
this phenomenon is still unknown, and its clinical impact on the
peri-operative outcome has been poorly investigated. Method(s): A
systematic review and a meta-analysis of all available studies reporting
data about peri-procedural thrombocytopenia on isolated bio-AVR, comparing
rapid-deployment (RDV), stentless (stentless-AVR), and TAVI vs. stented
(stented-AVR) valves, have been performed. Result(s): Fifteen trials
(2.163 patients) were included in the meta-analysis. Perioperative
platelet reduction ranged from 35% to 55% in stented-AVR, from 60% to 77%
in stentless-AVR, from 53% to 60% in RDV, and from to 21% to 72% in TAVI
(apparently, balloon-expandable valves more frequently associated to
thrombocytopenia). Stented-AVR required more red blood cells transfusion
than stentless-AVR (P < 0.0001), whereas no difference has been found
between RDV and stented-AVR. Platelet transfusion rate was very low in all
surgical groups. No difference has been found in RDV and stentless-AVR vs.
stented-AVR, in terms of reoperation for bleeding, and length-of-intensive
care unit or hospital stay. Conclusion(s): Thrombocytopenia-related
major adverse events were mainly reported in TAVI patients, whereas
clinically meaningless in surgical patients. Transient peri-procedural
thrombocytopenia is common after bio-AVR, regardless of prosthesis's type
or implant modality. It should receive appropriate monitoring and focused
investigations. Copyright © 2019 The Authors

<35>
[Use Link to view the full text]
Accession Number
629515843
Title
Compare the prognosis of da Vinci robot-Assisted thoracic surgery (RATS)
with video-Assisted thoracic surgery (VATS) for non-small cell lung
cancer: A Meta-Analysis.
Source
Medicine (United States). 98 (39) (no pagination), 2019. Article Number:
e17089. Date of Publication: 01 Sep 2019.
Author
Guo F.; Ma D.; Li S.; Adamek M.
Institution
(Guo, Ma, Li, Adamek) Department of Thoracic Surgery, Peking Union Medical
College Hospital, Peking Union Medical College, Beijing, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
To determine if there are advantages to transitioning to Da Vinci robotics
by a surgeon compared to the video-Assisted thoracic surgical lobectomy.A
systematic electronic search of online electronic databases: PubMed,
Embase, and Cochrane library updated on December 2017. Publications on
comparison Da Vinci-robot-Assisted thoracic surgery (RATS) and
video-Assisted thoracic surgery (VATS) for non-small cell lung cancer were
collected. Meta-Analysis RevMan 5.3 software (The Cochrane collaboration,
Oxford, UK) was used to analyze the combined pooled HRs using fixed or
random-effects models according to the heterogeneity.Fourteen
retrospective cohort studies were included. No statistical difference was
found between the 2 groups with respect to conversion to open, dissected
lymph nodes number, hospitalization time after surgery, duration of
surgery, drainage volume after surgery, prolonged air leak, and morbidity
(P>.05).Da Vinci-RATS lobectomy is a feasible and safe technique and can
achieve an equivalent surgical efficacy when compared with VATS. There
does not seem to be a significant advantage for an established VATS
lobectomy surgeon to transition to robotics based on clinical
outcomes. Copyright © 2019 the Author(s). Published by Wolters
Kluwer Health, Inc.

<36>
Accession Number
2003272732
Title
BARI 2D: A Reanalysis Focusing on Cardiovascular Events.
Source
Mayo Clinic Proceedings. (no pagination), 2019. Date of Publication: 2019.
Author
Genuth S.M.; Vlachos H.; Brooks M.M.; Bantle J.P.; Chaitman B.R.; Green
J.; Kelsey S.F.; King S.B.; McBane R.; Sako E.Y.; Schneider D.J.; Steffes
M.; Frye R.L.
Institution
(Genuth) Division of Clinical and Molecular Endocrinology, Department of
Medicine, Case Western Reserve University, Cleveland, OH, United States
(Vlachos, Brooks, Kelsey) Epidemiology Data Center, University of
Pittsburgh, PA, United States
(Bantle, Steffes) Department of Medicine, University of Minnesota,
Minneapolis, United States
(Bantle, Steffes) Department of Laboratory Medicine and Pathology,
University of Minnesota, Minneapolis, United States
(Chaitman) Division of Cardiology, Department of Medicine, St. Louis
University, MO, United States
(Green) Division of Endocrinology, Department of Medicine, Duke University
Medical Center, Durham, NC, United States
(King) Emory University School of Medicine, Atlanta, GA, United States
(McBane, Frye) Mayo Clinic, Rochester, MN, United States
(Sako) Department of Cardiothoracic Surgery, University of Texas Health
Science Center at San Antonio
(Schneider) Department of Medicine, University of Vermont Medical Center,
Burlington, United States
Publisher
Elsevier Ltd
Abstract
Objective: To reanalyze the Bypass Angioplasty Revascularization
Investigation 2 Diabetes trial using a new composite cardiovascular
disease (CVD) outcome to determine how best to treat patients with type 2
diabetes mellitus and stable coronary artery disease. Patients and
Methods: From January 1, 2001, to November 30, 2008, 2368 patients with
type 2 diabetes mellitus and angiographically proven coronary artery
disease were randomly assigned to insulin-sensitizing (IS) or
insulin-providing (IP) therapy and simultaneously to coronary
revascularization (REV) or no or delayed REV (intensive medical therapy
[MED]), with all patients receiving intensive medical treatment. The
outcome of this analysis was a composite of 8 CVD events. Result(s):
Four-year Kaplan-Meier rates for the composite CVD outcome were 35.8% (95%
CI, 33.1%-38.5%) with IS therapy and 41.6% (95% CI, 38.7%-44.5%) with IP
therapy (P=.004). Much of this difference was associated with lower
in-trial levels of fibrinogen, C-reactive protein, and hemoglobin
A<inf>1c</inf> with IS therapy. Four-year composite CVD rates were 32.7%
(95% CI, 30.0%-35.4%) with REV and 44.7% (95% CI, 41.8%-47.6%) with MED
(P<.001). A beneficial effect of IS vs IP therapy was present with REV
(27.7%; 95% CI, 24.0%-31.4% vs 37.5%; 95% CI, 33.6%-41.4%; P<.001), but
not with MED (43.6%; 95% CI, 39.5%-47.7% vs 45.7%; 95% CI, 41.6%-49.8%;
P=.37) (homogeneity, P=.05). This interaction between IS therapy and REV
was limited to participants preselected for coronary artery bypass
grafting (CABG). The lowest composite CVD rates occurred in patients
preselected for CABG and assigned to IS therapy and REV (17.3%; 95% CI,
11.8%-22.8%). Conclusion(s): In the Bypass Angioplasty
Revascularization Investigation 2 Diabetes trial, the IS treatment
strategy and the REV treatment strategy each reduces cardiovascular
events. The combination of IS drugs and CABG results in the lowest risk of
subsequent CVD events. Trial Registration: clinicaltrials.gov Identifier:
NCT00006305 Copyright © 2019 Mayo Foundation for Medical
Education and Research

<37>
Accession Number
2003186106
Title
Effect of Dexmedetomidine on Cardiac Surgery-Associated Acute Kidney
Injury: A Meta-Analysis With Trial Sequential Analysis of Randomized
Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2019.
Date of Publication: 2019.
Author
Peng K.; Li D.; Applegate R.L.; Lubarsky D.A.; Ji F.-H.; Liu H.
Institution
(Peng, Ji) Department of Anesthesiology, First Affiliated Hospital of
Soochow University, Suzhou, Jiangsu, China
(Peng, Li, Applegate, Lubarsky, Liu) Department of Anesthesiology and Pain
Medicine, University of California Davis Health, Sacramento, CA, United
States
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgery-associated acute kidney injury (CS-AKI) is
associated with high mortality rates. This study aimed to determine the
effects of perioperative dexmedetomidine (DEX) administration on CS-AKI in
adult patients. Design(s): A meta-analysis with trial sequential
analysis of randomized controlled trials. Setting(s): PubMed, EMBASE,
Cochrane Library, and China National Knowledge Infrastructure databases
were searched up to March 11, 2019 for relevant articles. The study
protocol was registered at the International Prospective Register of
Systematic Reviews (registration number: CRD42019128139).
 Participant(s): Adult patients undergoing cardiac surgery.
 Intervention(s): Dexmedetomidine compared with controls.
 Measurements and Main Results: Nine randomized controlled trials with
a total of 1,308 patients were included. Use of DEX significantly reduced
the incidence of CS-AKI (risk ratio = 0.60, 95% confidence interval =
0.41-0.87, p = 0.008, I2 = 30%), without significant
publication bias. The trial sequential analysis result suggested that
there was enough evidence for this outcome. Sensitivity analysis confirmed
the robustness of the result. The improvement of CS-AKI was primarily
significant in preoperative and/or intraoperative administration of DEX
with or without postoperative continuation, patients with age >=60 years,
and studies with low risk of bias. The subgroup analysis did not show
statistical differences. Dexmedetomidine use also was associated with less
prolonged ventilation and lower incidences of pulmonary complications and
delirium postoperatively. The level of evidence was high for the incidence
of CS-AKI on the Grading of Recommendations Assessment, Development and
Evaluation profile. Conclusion(s): Perioperative DEX administration
provided protective effects against CS-AKI, especially when initiated
before and during surgery in elderly patients. Copyright © 2019
Elsevier Inc.

<38>
Accession Number
2003282526
Title
Weighing Coronary Revascularization Options in Patients With Type 2
Diabetes Mellitus.
Source
Canadian Journal of Diabetes. (no pagination), 2019. Date of Publication:
2019.
Author
Godoy L.C.; Tavares C.A.M.; Farkouh M.E.
Institution
(Godoy, Farkouh) Peter Munk Cardiac Centre, University of Toronto,
Toronto, Ontario, Canada
(Godoy, Farkouh) Heart and Stroke/Richard Lewar Centres of Excellence in
Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada
(Godoy, Tavares) Instituto do Coracao, Faculdade de Medicina, Universidade
de Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier B.V.
Abstract
Patients with diabetes mellitus (DM) are at increased risk for developing
coronary artery disease. Choosing the optimal revascularization strategy,
such as coronary artery bypass grafting or percutaneous coronary
intervention (PCI), may be difficult in this population. A large body of
evidence suggests that, for patients with DM and stable multivessel
ischemic heart disease, coronary artery bypass grafting is usually
superior to PCI, leading to lower rates of all-cause mortality, myocardial
infarction and repeat revascularization in the long term. In patients with
less complex coronary anatomy (2- or single-vessel disease, especially
without involvement of the proximal left anterior descendent artery), PCI
may be a viable option. Because these anatomic patterns are less frequent
in patients with DM, there is less evidence to guide revascularization in
these cases. Patients with DM and left main disease and those in the acute
coronary syndrome setting are also underrepresented in randomized trials,
and the best revascularization strategy for these patients is not clear.
Once the revascularization procedure is performed, patients should be kept
engaged in controlling the risk factors for progression of cardiovascular
disease. Avoidance of smoking, control of cholesterol, blood pressure and
glycemic levels; regular practice of physical activity of at least
moderate intensity; and a balanced diet are of key importance in the
post-revascularization period. In this study, we review the current
literature in the management of patients with DM and coronary artery
disease undergoing a revascularization procedure. Copyright ©
2019 Canadian Diabetes Association

<39>
Accession Number
2002844873
Title
Application techniques of a novel hemostat in cardiac operations:
HEMOBLAST.
Source
Journal of Cardiac Surgery. 34 (9) (pp 849-853), 2019. Date of
Publication: 01 Sep 2019.
Author
Bruckner B.A.; Ngo U.; Ramchandani M.; Suarez E.; Awad S.; Reardon M.
Institution
(Bruckner, Ngo, Ramchandani, Suarez, Reardon) Houston Methodist Hospital,
Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
(Awad) Department of Surgery, Michael E. DeBakey Veterans Affairs Medical
Center, Houston, TX, United States
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Postoperative bleeding complications are associated with less
favorable outcomes in cardiac surgery and contribute to excessive overall
healthcare costs. HEMOBLAST (Biom'up, Lyon, France) (HB) is a novel
ready-to-use hemostatic powder that consists of porcine collagen, bovine
chondroitin sulfate, and human pooled plasma thrombin that may help reduce
surgical bleeding. Aim(s): The aim of this study was to describe the
techniques of application for this new combination powder-based hemostat,
HB, and demonstrate its use employing photographs of application methods
during cardiac procedures. Material(s) and Method(s): The initial 24
procedures in which HB was used at our institution included: left
ventricular assist device (LVAD) insertions, lung transplants, heart
transplants, aortic valve replacements, coronary artery bypass grafting,
and mitral valve repair. Result(s): Hemostasis was achieved in all
cases and there were no instances of mediastinitis, sternal infections,
allergic reactions, or 30-day mortality. Discussion(s): This report
describes the best methods of application of HB including use for
treatment of mediastinal bleeding in a re-operative procedure in a patient
on antiplatelet agents and sternal bleeding during an LVAD insertion.
Proper application can facilitate excellent hemostasis using this powder.
 Conclusion(s): HB is a novel powder-based multiple component
hemostatic agent that promotes focal or large area hemostasis. We have
presented the techniques of use that are important to the successful
application of HB to facilitate hemostasis. Copyright © 2019 The
Authors. Journal of Cardiac Surgery Published by Wiley Periodicals, Inc.

<40>
Accession Number
629554197
Title
Perioperative Gabapentin in Pediatric Thoracic Surgery
Patients-Randomized, Placebo-Controlled, Phase 4 Trial.
Source
Pain medicine (Malden, Mass.). (no pagination), 2019. Date of Publication:
09 Oct 2019.
Author
Tomaszek L.; Fenikowski D.; Maciejewski P.; Komotajtys H.; Gawron D.
Institution
(Tomaszek, Fenikowski, Maciejewski, Komotajtys, Gawron) Department of
Thoracic Surgery, Institute of Tuberculosis and Lung Diseases, Rabka-Zdroj
Branch, Poland
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To determine whether the use of perioperative gabapentin
reduces postoperative pain and anxiety, decreases ropivacaine consumption
and side effects, and improves patient satisfaction. DESIGN: Randomized,
placebo-controlled, phase 4 trial. BLINDING: Participants, care providers,
investigators, data analysts. SETTING: Department of Thoracic Surgery of
the Institute of Tuberculosis and Lung Disease, Rabka Zdroj Branch,
Poland. SUBJECTS: Forty patients undergoing the Ravitch procedure.
 METHOD(S): Patients aged nine to 17years were randomized into a
gabapentin (preoperative 15mg/kg, treatment) or placebo group.
Postoperative analgesia included gabapentin (7.5mg/kg) or placebo two
times per day for three days, epidural ropivacaine + fentanyl,
paracetamol, nonsteroidal anti-inflammatory drugs, and metamizol as a
"rescue drug." Pain, anxiety, analgesic consumption, side effects, and
patient satisfaction were recorded. RESULT(S): There was no
statistically significant difference in median pain scores (numerical
rating scale < 1/10) or incidence of adverse side effects between the
gabapentin group (N=20) and the placebo group (N=20). Postoperative
anxiety scores were significantly lower than before surgery in the
gabapentin group (6 [4-8] vs 7 [6-8.5], P < 0.01) and remained unchanged
in the placebo group (6 [5-6.5] vs 6 [5-7], P = 0.07). Gabapentin-treated
patients received a lower number of doses of ondansetron when compared
with the placebo group (6 [5-6] vs 7 [6-9], P = 0.02). A significant
negative association was found between patient satisfaction and
postoperative state anxiety in the gabapentin group (R = -0.51, P = 0.02).
 CONCLUSION(S): Perioperative administration of gabapentin resulted in
a decrease of postoperative anxiety in pediatric patients undergoing the
Ravitch procedure. Copyright © 2019 American Academy of Pain
Medicine. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<41>
Accession Number
629553055
Title
The Healthy Heart-Mind Trial: Randomized Controlled Trial of Melatonin for
Prevention of Delirium.
Source
Journal of the American Geriatrics Society. (no pagination), 2019. Date of
Publication: 08 Oct 2019.
Author
Ford A.H.; Flicker L.; Kelly R.; Patel H.; Passage J.; Wibrow B.; Anstey
M.; Edwards M.; Almeida O.P.
Institution
(Ford, Flicker, Kelly, Patel, Wibrow, Anstey, Almeida) Medical School,
University of Western Australia, Perth, WA, Australia
(Ford, Flicker) WA Centre for Health & Ageing, University of Western
Australia, Perth, WA, Australia
(Passage) School of Medicine, University of Notre Dame and Department of
Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA,
Australia
(Wibrow, Anstey) Intensive Care Unit, Sir Charles Gairdner Hospital,
Perth, WA, Australia
(Edwards) Department of Cardiothoracic Surgery, Fiona Stanley Hospital,
Perth, WA, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Delirium is a serious medical condition with increased
incidence in at-risk surgical populations. We sought to determine if
melatonin use reduces the incidence of delirium in individuals undergoing
major cardiac surgery. DESIGN: Randomized double-blind placebo-controlled
clinical trial (two arms, 1:1 allocation, parallel design). SETTING: The
trial took place in two metropolitan hospitals (public tertiary and
private) in Perth, Western Australia. PARTICIPANTS: We recruited 210
adults aged 50years or older who were due to undergo coronary artery
bypass grafting or valve replacement surgery. INTERVENTION: Participants
were randomly assigned (1:1) to 7days of treatment with melatonin 3 mg at
night or matching placebo, starting 2days before the surgery.
MEASUREMENTS: The primary outcome of interest was incident delirium within
7days of surgery as assessed via daily clinical assessment that included
the Confusion Assessment Method. Secondary outcomes of interest included
duration and severity of delirium, length of hospital stay, cognitive
function, and mood and anxiety symptoms at discharge and 3 months after
the surgery. RESULT(S): The groups were well balanced for demographic
and clinical parameters. Forty-two participants developed delirium, but it
was evenly distributed between the groups (melatonin 21/98, 21.4%; placebo
21/104, 20.2%; adjusted odds ratio [OR] = .78; 95% confidence interval
[CI] = .35-1.75). The median duration of delirium was 3 (interquartile
range [IQR] = 2-4) and 2 (IQR = 1-3) days for people treated with
melatonin and placebo, respectively (z = -1.03; P = .304). A similar
proportion of participants experienced severe episodes of delirium in each
group (melatonin 9/21, 42.9% vs placebo 6/21, 28.6%; chi2 = .93; P = .334;
adjusted OR = 1.98; 95% CI = .40-9.78). The groups did not differ in terms
of length of stay, mood, anxiety, and cognitive performance.
 CONCLUSION(S): The findings of this randomized double-blind
placebo-controlled trial do not support the prophylactic use of melatonin
to prevent delirium after major cardiac surgery. Copyright © 2019
The American Geriatrics Society.

<42>
Accession Number
629540916
Title
Ramucirumab plus erlotinib in patients with untreated, EGFR-mutated,
advanced non-small-cell lung cancer (RELAY): a randomised, double-blind,
placebo-controlled, phase 3 trial.
Source
The Lancet. Oncology. (no pagination), 2019. Date of Publication: 04 Oct
2019.
Author
Nakagawa K.; Garon E.B.; Seto T.; Nishio M.; Ponce Aix S.; Paz-Ares L.;
Chiu C.-H.; Park K.; Novello S.; Nadal E.; Imamura F.; Yoh K.; Shih J.-Y.;
Au K.H.; Moro-Sibilot D.; Enatsu S.; Zimmermann A.; Frimodt-Moller B.;
Visseren-Grul C.; Reck M.
Institution
(Nakagawa) Department of Medical Oncology, Kindai University Faculty of
Medicine, Osaka, Japan
(Garon) David Geffen School of Medicine at University of California Los
Angeles, Translational Research in Oncology US Network, Los Angeles, CA,
USA
(Seto) National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
(Nishio) Department of Thoracic Medical Oncology, Cancer Institute
Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
(Ponce Aix, Paz-Ares) H12O-CNIO Lung Cancer Clinical Research Unit,
Universidad Complutense and Ciberonc, Hospital Universitario 12 de
Octubre, Madrid, Spain
(Chiu) Department of Chest Medicine, Taipei Veterans General Hospital,
Taipei, Taiwan (Republic of China)
(Park) Samsung Medical Center, Division of Hematology and Oncology,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Novello) Department of Oncology, University of Turin, Azienda
ospedaliero-universitaria San Luigi, Orbassano, Italy
(Nadal) Department of Medical Oncology, Catalan Institute of Oncology,
Clinical Research in Solid Tumors group, l'Institut d'Investigacio
Biomedica de Bellvitge, L'Hospitalet, Barcelona, Spain
(Imamura) OsakaJapan
(Yoh) National Cancer Center Hospital East, Kashiwa, Japan
(Shih) Department of Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Au) Queen Elizabeth Hospital, Kowloon, Hong Kong
(Moro-Sibilot) Grenoble University Hospital, Grenoble, France
(Enatsu) Eli Lilly Japan KK Kobe, Kobe, Japan
(Zimmermann) Eli Lilly and Company, IN, Indianapolis, United States
(Frimodt-Moller) Eli Lilly and Company, Copenhagen, Denmark
(Visseren-Grul) Lilly Oncology, Utrecht, Netherlands
(Reck) LungenClinic, Airway Research Center North, German Center for Lung
Research, Grosshansdorf, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Dual blockade of the EGFR and VEGF pathways in EGFR-mutated
metastatic non-small-cell lung cancer (NSCLC) is supported by preclinical
and clinical data, yet the approach is not widely implemented. RELAY
assessed erlotinib, an EGFR tyrosine kinase inhibitor (TKI) standard of
care, plus ramucirumab, a human IgG1 VEGFR2 antagonist, or placebo in
patients with untreated EGFR-mutated metastatic NSCLC. METHOD(S):
This is a worldwide, double-blind, phase 3 trial done in 100 hospitals,
clinics, and medical centres in 13 countries. Eligible patients were aged
18 years or older (20 years or older in Japan and Taiwan) at the time of
study entry, had stage IV NSCLC, with an EGFR exon 19 deletion (ex19del)
or exon 21 substitution (Leu858Arg) mutation, an Eastern Cooperative
Oncology Group performance status of 0 or 1, and no CNS metastases. We
randomly assigned eligible patients in a 1:1 ratio to receive oral
erlotinib (150 mg/day) plus either intravenous ramucirumab (10 mg/kg) or
matching placebo once every 2 weeks. Randomisation was done by an
interactive web response system with a computer-generated sequence and
stratified by sex, geographical region, EGFR mutation type, and EGFR
testing method. The primary endpoint was investigator-assessed
progression-free survival in the intention-to-treat population. Safety was
assessed in all patients who received at least one dose of study
treatment. This trial is registered at ClinicalTrials.gov, NCT02411448,
and is ongoing for long-term survival follow-up. FINDINGS: Between Jan 28,
2016, and Feb 1, 2018, 449 eligible patients were enrolled and randomly
assigned to treatment with ramucirumab plus erlotinib (n=224) or placebo
plus erlotinib (n=225). Median duration of follow-up was 20.7 months (IQR
15.8-27.2). At the time of primary analysis, progression-free survival was
significantly longer in the ramucirumab plus erlotinib group (19.4 months
[95% CI 15.4-21.6]) than in the placebo plus erlotinib group (12.4 months
[11.0-13.5]), with a stratified hazard ratio of 0.59 (95% CI 0.46-0.76;
p<0.0001). Grade 3-4 treatment-emergent adverse events were reported in
159 (72%) of 221 patients in the ramucirumab plus erlotinib group versus
121 (54%) of 225 in the placebo plus erlotinib group. The most common
grade 3-4 treatment-emergent adverse events in the ramucirumab plus
erlotinib group were hypertension (52 [24%]; grade 3 only) and dermatitis
acneiform (33 [15%]), and in the placebo plus erlotinib group were
dermatitis acneiform (20 [9%]) and increased alanine aminotransferase (17
[8%]). Treatment-emergent serious adverse events were reported in 65 (29%)
of 221 patients in the ramucirumab plus erlotinib group and 47 (21%) of
225 in the placebo plus erlotinib group. The most common serious adverse
events of any grade in the ramucirumab plus erlotinib group were pneumonia
(seven [3%]) and cellulitis and pneumothorax (four [2%], each); the most
common in the placebo plus erlotinib group were pyrexia (four [2%]) and
pneumothorax (three [1%]). One on-study treatment-related death due to an
adverse event occurred (haemothorax after a thoracic drainage procedure
for a pleural empyema) in the ramucirumab plus erlotinib group.
INTERPRETATION: Ramucirumab plus erlotinib demonstrated superior
progression-free survival compared with placebo plus erlotinib in patients
with untreated EGFR-mutated metastatic NSCLC. Safety was consistent with
the safety profiles of the individual compounds in advanced lung cancer.
The RELAY regimen is a viable new treatment option for the initial
treatment of EGFR-mutated metastatic NSCLC. FUNDING: Eli
Lilly. Copyright © 2019 Elsevier Ltd. All rights reserved.

<43>
Accession Number
2002867710
Title
Congenital Heart Disease and Thyroid Dysfunction: Combination,
Association, and Implication.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 10 (5) (pp
604-615), 2019. Date of Publication: 01 Sep 2019.
Author
Lerner R.K.; Gruber N.; Pollak U.
Institution
(Lerner) Department of Pediatrics, The Edmond and Lily Safra Children's
Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
(Lerner, Gruber) The Sackler Faculty of Medicine, Tel Aviv University, Tel
Aviv, Israel
(Gruber) Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra
Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
(Pollak) Pediatric Cardiac Critical Care Unit, Hadassah University Medical
Center, Ein Kerem, Jerusalem, Israel
(Pollak) Pediatric Cardiology, Hadassah University Medical Center, Ein
Kerem, Jerusalem, Israel
(Pollak) Pediatric Extracorporeal Support Program, Hadassah University
Medical Center, Ein Kerem, Jerusalem, Israel
(Pollak) The Hebrew University Hadassah Medical School, Jerusalem, Israel
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Patients with congenital heart disease have higher prevalence
of thyroid dysfunction due to embryonic and genetic coexistence. Marked
changes in cardiac function occur secondary to alternations in thyroid
hormone levels. Cardiac catheterizations or cardiac surgeries with
cardiopulmonary bypass can cause abnormalities in the circulating
hormones, in the absence of primary thyroid disease. Therefore, monitoring
of thyroid function should be routinely performed in children with
congenital heart disease. Thyroid hormone supplementation has been
postulated as a possible therapeutic option; however, the therapeutic
decisions should be made based on individual circumstances, symptoms, and
the severity of the thyroid dysfunction. Objective(s): To describe
the correlation between congenital heart disease in children and thyroid
dysfunction and the debate on monitoring, intervention, and treatment.
 Method(s): PubMed, Clinical Key, and the Cochrane Library were
searched using keywords relevant to congenital heart disease/surgery,
cardiopulmonary bypass, thyroid hormones, sick euthyroid syndrome, and
cardiac catheterization. Studies were limited to the English language and
to children 0 to 18 years old. Studies in adults with important findings
were reviewed as well. All clinical studies believed to have relevance
were considered. All relevant studies were reviewed, and the most
pertinent data were incorporated in this review. Conclusion(s): There
is lack of significant evidence concerning treatment for thyroid
dysfunction in children with a congenital cardiac diagnosis. Adequately
powered studies are needed before a uniform recommendation about treatment
can be made. Copyright © The Author(s) 2019.

<44>
Accession Number
629421476
Title
Streamlining the treatment of cardiac arrest after cardiac surgery.
Source
Southern African Journal of Critical Care. Conference: 2019 National
Annual Congress of the Critical Care Society of Southern Africa. South
Africa. 35 (1) (pp 29), 2019. Date of Publication: 2019.
Author
Van Der Merwe J.; Verbeek R.; Levine A.; Dunning J.
Institution
(Van Der Merwe, Verbeek) Cardia Surgical Unit Advanced Life Support
(CSU-ALS), South Africa/ Atlantic Cardiovascular and Thoracic Institute,
Netcare Blaauwberg Hospital, Cape Town, South Africa
(Levine, Dunning) James Cook University Hospital, Department of
Cardiothoracic Surgery, Middlesbrough, United Kingdom
Publisher
South African Medical Association
Abstract
Background. Cardiac arrest after cardiac surgery (CACS) is associated with
poor outcomes, and presents unique challenges to the cardiac critical care
team. Objective. It is our intention to introduce recently published
internationally endorsed CACS resuscitation protocols to South African
critical care providers and to provide a training platform from which
these principles can be incorporated into routine cardiac critical care.
Methods. Evidence to create international CACS protocols were obtained
from existing guidelines, the International Liaison Committee on
Resuscitation, international online surveys and from MEDLINE keyword
searches for human clinical studies, animal models and simulation
protocols relevant to CACS. Results. In total, 56 publications were
identified to create CACS recommendations. Internal massage (IM) is more
effective than external massage (EM) in CACS and should be used
preferentially if reversible causes are excluded. External massage (EM) is
ineffective in tamponade or hypovolemia and only salvageable by emergency
re-sternotomy (ER) within 5 minutes. CACS arrhythmias require unique
interventions, as does the administration of resuscitation medication
including Epinephrine. Conclusion. CACS requires unique skillsets, an
efficient critical care team with allocated key roles and protocols that
differ from commonly used advance cardiac life support guidelines. CACS
can potentially be prevented and effectively treated by applying
specialised protocols and principles.

<45>
Accession Number
629421342
Title
Assessment of research productivity of published articles in the critical
care unit of cardiac surgery patients.
Source
Critical Care. Conference: 10th International Symposium on Intensive Care
and Emergency Medicine for Latin America. Brazil. 23 (Supplement 3) (no
pagination), 2019. Date of Publication: 2019.
Author
Da Silva A.A.; Costa L.A.A.; Nascimento A.C.S.; Souza P.M.S.; Dias T.L.;
Pedrosa M.R.; Pimentel W.S.P.; Ranzani R.C.M.
Institution
(Da Silva, Costa, Nascimento, Souza, Dias, Pedrosa, Pimentel, Ranzani)
UNIFESP-UTI Cirurgia Cardiaca, Hospital Sao Paulo, Sao Paulo, SP, Brazil
(Da Silva, Pimentel) HIAE-Hospital Israelita Albert Einstein, Sao Paulo,
SP, Brazil
Publisher
BioMed Central Ltd.
Abstract
Background Cardiac surgery is a standard procedure worldwide. Many of the
patients have been followed in the intensive care unit (ICU) after
surgery. Many concerns about intensive care treatment could be solved by
publication in the literature. Research is an essential and unique field
that intensivists all over the world deal with, in addition to their daily
clinical practice. Published articles represent a central part of the
research process. Objective We aimed to assess the current quality of
evidence from published papers in Scopus Database of the management of
cardiac surgical patients in the critical care unit. Methods An internet
electronic search was made in the Scopus database looking for published
articles between 2004 and 2018. The search strategy involved core terms
related to CCM and the specific search strategy was as follows:
TITLE-ABS-KEY ( "cardiac surgery" ) OR TITLEABS- KEY ( "heart surgery" )
AND TITLE-ABS-KEY ( "intensive care" ) OR TITLE-ABS-KEY ( "critical care"
) AND TITLE-ABS-KEY ( adult ) AND NOT TITLE-ABS-KEY ( animal ) AND (
LIMIT-TO ( SRCTYPE , "j" ) ). There were no restrictions on language but
the abstract should be written in English. Results A total of 4326
articles were identified using predefined search words. Almost all of them
(4014) were published in English, with 1075 published in the United
States. The five most important journals were Journal of Cardiothoracic
and Vascular Anesthesia (impact factor (IF) = 0.2), Annals of Thoracic
Surgery (IF = 1.2), Critical Care Medicine (IF = 3.88), Journal of
Thoracic and Cardiovascular Surgery (IF = 2.26) and European Journal of
Cardio-Thoracic Surgery (IF = 1.5). Overall, 112 systematic reviews have
been published and only seven were published in the Cochrane Database of
Systematic Reviews (IF = 6.22). Conclusions Many cardiac surgical patients
have been monitored in the ICU, although a search on research on this has
found low numbers of good papers and systematic reviews within this group
of patients. Improving the quality of studies will provide high-quality
intensive care management after cardiac surgery.

<46>
Accession Number
2002925074
Title
Transcatheter Cardiovascular Therapeutics Abstracts.
Source
Journal of the American College of Cardiology. Conference: Thirty First
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). United
States. 74 (13 Supplement) (pp B1-B860), 2019. Date of Publication: 1
October 2019.
Author
Anonymous
Publisher
Elsevier USA
Abstract
The proceedings contains 827 papers. The topics discussed include: TCT-1 A
Novel Risk-Based Strategy in Adopting New Technology: Pilot Study
Assessing Clinical and Quality Outcomes of Real-World Intravascular
Ultrasound (IVUS) and Instant Wave-Free Ratio (iFR) Utilization in a
Unique Risk-Sharing Program;TCT-2 Paravalvular Regurgitation After
Transcatheter Aortic Valve Replacement in Moderate-Risk Patients: A Pooled
PARTNER 2 Trial and Registry Study;TCT-3 Modified Body Mass Index, A Novel
Marker of Malnutrition and Clinical Frailty, is Associated With Outcomes
After Transcatheter and Surgical Aortic Valve Replacement;TCT-4
Transcatheter Tricuspid Valve Repair in Patients With Functional Tricuspid
Regurgitation: 2-Year Outcomes From the FORMA US Early Feasibility
Study;TCT-5 Is Surgical Aortic Valve Replacement Still an Option for
Radiation-Induced Aortic Stenosis in the Transcatheter Aortic Valve
Replacement Era?;TCT-6 Incidence and Predictors of Hemodynamic
Deterioration of Transcatheter and Surgical Bioprosthetic Aortic Valves:
Pooled Analysis From the CoreValve Pivotal Trials;TCT-7 Blinded Outcomes
Assessment of Absorb Bioresorbable Scaffolds Implanted With Improved
Technique: 2-Year Results From the ABSORB IV Randomized Trial;TCT-8
Updated 30-Day Outcomes for the U.S. Early Feasibility Study of the SAPIEN
M3 Transcatheter Mitral Valve Replacement System;TCT-9 Quantitative
Assessment of Lipid Composition by NIRS-IVUS Is Helpful for
Differentiating Among Plaque Rupture, Plaque Erosion, and Calcified Nodule
in the Culprit Lesion of ACS;TCT-10 Time and Mortality in ST-Segment
Elevation Myocardial Infarction: Insights From the TOTAL Trial;TCT-11
Everolimus-Eluting Bioresorbable Scaffolds Versus Drug-Eluting Stents in
Patients With Acute Myocardial Infarction: 2-Year Results of the
Randomized ISAR-Absorb MI Trial;TCT-12 Results From the CAMI1 Study:
Selective CRP Apheresis as a New Treatment Option in Acute Myocardial
Infarction;TCT-243 Rotablation Approach for Bifurcation Lesions

<47>
Accession Number
623770577
Title
Efficacy and safety of further lowering of low-density lipoprotein
cholesterol in patients starting with very low levels: A meta-analysis.
Source
JAMA Cardiology. 3 (9) (pp 823-828), 2018. Date of Publication: September
2018.
Author
Sabatine M.S.; Wiviott S.D.; Im K.; Murphy S.A.; Giugliano R.P.
Institution
(Sabatine, Wiviott, Im, Murphy, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, Hale Bldg for Transformative Medicine, 60 Fenwood Rd, Boston, MA
02115, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE In the Cholesterol Treatment Trialists Collaboration (CTTC), in
patients starting with low-density lipoprotein cholesterol (LDL-C) levels
of approximately 3.4 mmol/L (131.5mg/dL), there was a 22%reduction in
major vascular events per 1-mmol/L (38.7-mg/dL) lowering of LDL-C. The
magnitude of clinical benefit of further LDL-C lowering in patients
already with very low LDL-C levels remains debated. OBJECTIVE To evaluate
efficacy and safety of further lowering LDL-C levels in patient
populations presenting with median LDL-C levels of 1.8 mmol/L (70mg/dL) or
less. DATA SOURCES AND STUDY SELECTION The CTTCwas used for statin data.
For nonstatin therapy, Medline database was searched (2015-April 2018).
Key inclusion criteria were a randomized, double-blind, controlled
cardiovascular outcome trial of LDL-C lowering with data in populations
starting with LDL-C levels averaging 1.8 mmol/L (70mg/dL) or less. DATA
EXTRACTION AND SYNTHESIS Two authors independently extracted data into
standardized data sheets, and data were analyzed using meta-analysis. MAIN
OUTCOMES AND MEASURES The risk ratio (RR) of major vascular events (a
composite of coronary heart death,myocardial infarction, ischemic stroke,
or coronary revascularization) per 1-mmol/L (38.7-mg/dL) reduction in
LDL-C level. RESULTS In the subgroup of patients from the CTTC
meta-analysis of statins with a mean LDL-C in the control arm of 1.7
mmol/L (65.7mg/dL), 1922 major vascular events occurred and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.78 (95%CI, 0.65-0.94). For 3 trials of nonstatin LDL-C-lowering
therapies added to statins, there were 50 627 patients, the median LDL-C
in the control arms ranged from 1.6 mmol/L to 1.8 mmol/L (63mg/dL to
70mg/dL), and 9570 major vascular events occurred. Nonstatin therapy
lowered LDL-C by 0.3 to 1.2 mmol/L (11mg/dL to 45mg/dL), and the RR for
major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was
0.79 (95%CI, 0.70-0.88). For statins and nonstatins combined, the RR was
0.79 (95%CI, 0.71-0.87; P < .001). Low-density lipoprotein cholesterol
lowering was not associated with an increased risk of serious adverse
events,myalgias and/ormyositis, elevation in the level of
aminotransferases, new-onset diabetes, hemorrhagic stroke, or cancer.
CONCLUSIONS AND RELEVANCE There is a consistent relative risk reduction in
major vascular events per change in LDL-C in patient populations starting
as low as a median of 1.6 mmol/L (63mg/dL) and achieving levels as low as
a median of 0.5 mmol/L (21mg/dL), with no observed offsetting adverse
effects. These data suggest further lowering of LDL-C beyond the lowest
current targets would further reduce cardiovascular risk. Copyright
© 2018 American Medical Association. All rights reserved.

<48>
[Use Link to view the full text]
Accession Number
627082528
Title
Periprocedural outcomes of direct oral anticoagulants versus warfarin in
nonvalvular atrial fibrillation meta-analysis of phase III trials.
Source
Circulation. 138 (14) (pp 1402-1411), 2018. Date of Publication: 2018.
Author
Nazha B.; Pandya B.; Cohen J.; Zhang M.; Lopes R.D.; Garcia D.A.; Sherwood
M.W.; Spyropoulos A.C.
Institution
(Spyropoulos) Center for Health Innovations and Outcomes Research,
Feinstein Institute for Medical Research System, United States
(Spyropoulos) Anticoagulation and Clinical Thrombosis Services Northwell
Health, Lenox Hill Hospital, 130 E 77th St, New York, NY 10075, United
States
(Nazha) Department of Hematology and Medical Oncology, Emory University
School of Medicine, Atlanta, GA, United States
(Pandya) Division of Cardiology, Staten Island University
Hospital-Northwell Health, NY, United States
(Cohen) Division of Hospital Medicine, Northwell Health at North Shore
University Hospital, Manhasset, NY, United States
(Zhang, Spyropoulos) Center for Health Innovations and Outcomes Research,
Feinstein Institute for Medical Research, Manhasset, NY, United States
(Lopes) Division of Cardiology, Duke University Medical Center, Duke
Clinical Research Institute, Durham, NC, United States
(Garcia) Department of Medicine, Division of Hematology, University of
Washington School of Medicine, Seattle, United States
(Sherwood) Inova Heart and Vascular Institute, Fairfax, VA, United States
(Spyropoulos) Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell, Hempstead, NY, United States
(Spyropoulos) Department of Medicine, Anticoagulation and Clinical
Thrombosis Service, Northwell Health at Lenox Hill Hospital, New York, NY,
United States
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Direct oral anticoagulants (DOACs) are surpassing warfarin as
the anticoagulant of choice for stroke prevention in nonvalvular atrial
fibrillation. DOAC outcomes in elective periprocedural settings have not
been well elucidated and remain a source of concern for clinicians. The
aim of this meta-analysis was to evaluate the periprocedural safety and
efficacy of DOACs versus warfarin in patients with nonvalvular atrial
fibrillation. METHOD(S): We reviewed the literature for data from
phase III randomized controlled trials comparing DOACs with warfarin in
the periprocedural period among patients with nonvalvular atrial
fibrillation. Substudies from 4 trials (RELY [Randomized Evaluation of
Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral
Direct Factor Xa Inhibitor Compared with Vitamin K Antagonism for
Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE
[Apixaban for the Prevention of Stroke in Subjects With Atrial
Fibrillation], and ENGAGE-AF [Effective Anticoagulation With Factor xA
Next Generation in Atrial Fibrillation]) were included in the
meta-analysis. DOACs as a group and warfarin were compared in terms of the
30-day pooled risk for stroke/systemic embolism, major bleeding, and
death, according to whether the study drug was interrupted or not
periprocedurally. The overall relative risk (RR) was estimated with a
random-effects model. The I2 test was used to assess
heterogeneity in RR among the studies. RESULT(S): In the
uninterrupted anticoagulant strategy, there were no differences in the
rates of stroke/systemic embolism (pooled risk, 0.6% [29 events/4519
procedures] versus 1.1% [31/2971]; RR, 0.70; 95% confidence interval [CI],
0.41-1.18) and death (1.4% versus 1.8%; RR, 0.77; 95% CI, 0.53-1.12)
between DOACs and warfarin and significantly fewer major bleeding events
(2.0% versus 3.3%; RR, 0.62; 95% CI, 0.47-0.82) with DOACs compared to
warfarin. Under an interrupted strategy, there was no significant
difference between DOACs versus warfarin for stroke/ systemic embolism
(0.4% [41/9260] versus 0.5% [31/7168]; RR, 0.95; 95% CI, 0.59-1.55), major
bleeding (2.1% versus 2.0%; RR, 1.05; 95% CI, 0.85-1.30), and death (0.7%
versus 0.6%; RR, 1.24; 95% CI, 0.76-2.04). The studies were homogeneous
(I2=0.0%) for all calculated pooled associations except for the
RR of death in the interrupted strategy (I2=26.3%).
 CONCLUSION(S): The short-term safety and efficacy of DOACs and
warfarin are not different in patients with nonvalvular atrial
fibrillation periprocedurally. Under an uninterrupted anticoagulation
strategy, DOACs are associated with a 38% lower risk of major bleeding
compared with warfarin. Copyright © 2018 American Heart
Association, Inc.

<49>
[Use Link to view the full text]
Accession Number
627082390
Title
Myocardial revascularization trials: Beyond the printed word.
Source
Circulation. 138 (25) (pp 2943-2951), 2018. Date of Publication: 2018.
Author
Ruel M.; Falk V.; Farkouh M.E.; Freemantle N.; Gaudino M.F.; Glineur D.;
Cameron D.E.; Taggart D.P.
Institution
(Ruel, Glineur) University of Ottawa Heart Institute, University of
Ottawa, Ottawa, Canada
(Falk) German Heart Center, Charite Universitatsmedizin Berlin, Berlin,
Germany
(Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
(Freemantle) Institute of Clinical Trials and Methodology, University
College London, London, United Kingdom
(Gaudino) New York Presbyterian Hospital, Weill Cornell Medicine, NY,
United States
(Cameron) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Taggart) Oxford University Hospitals, Oxford, United Kingdom
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This article reviews the context and evidence of recent myocardial
revascularization trials that compared percutaneous coronary intervention
with coronary artery bypass grafting for the treatment of left main and
multivessel coronary artery disease. We develop the rationale that some of
the knowledge synthesis resulting from these trials, particularly with
regard to the claimed noninferiority of percutaneous coronary intervention
beyond nondiabetic patients with low anatomic complexity, may have been
affected by trial design, patient selection based on suitability for
percutaneous coronary intervention, and end point optimization favoring
percutaneous coronary intervention over coronary artery bypass grafting.
We provide recommendations that include holding a circumspect
interpretation of the currently available evidence, as well as suggestions
for the collaborative design and conduct of future clinical trials in this
and other fields. Copyright © 2018 American Heart Association,
Inc.

<50>
Accession Number
624778041
Title
Female sex reduces the risk of hospital-associated acute kidney injury: A
meta-analysis.
Source
BMC Nephrology. 19 (1) (no pagination), 2018. Article Number: 314. Date of
Publication: 08 Nov 2018.
Author
Neugarten J.; Golestaneh L.
Institution
(Neugarten, Golestaneh) Department of Medicine, Nephrology Division,
Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210
St, Bronx, NY 10467, United States
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Female sex has been included as a risk factor in models
developed to predict the development of AKI. In addition, the commentary
to the Kidney Disease Improving Global Outcomes Clinical Practice
Guideline for AKI concludes that female sex is a risk factor for
hospital-acquired AKI. In contrast, a protective effect of female sex has
been demonstrated in animal models of ischemic AKI. Method(s): To
further explore this issue, we performed a meta-analysis of AKI studies
published between January, 1978 and April, 2018 and identified 83 studies
reporting sex-stratified data on the incidence of hospital-associated AKI
among nearly 240,000,000 patients. Result(s): Twenty-eight studies
(6,758,124 patients) utilized multivariate analysis to assess risk factors
for hospital-associated AKI and provided sex-stratified ORs. Meta-analysis
of this cohort showed that the risk of developing hospital-associated AKI
was significantly greater in men than in women (OR 1.23 (1.11,1.36). Since
AKI is not a single disease but instead represents a heterogeneous group
of disorders characterized by an acute reduction in renal function, we
performed subgroup meta-analyses. The association of male sex with AKI was
strongest among studies of patients who underwent non-cardiac surgery.
Male sex was also associated with AKI in studies which included unselected
hospitalized patients and in studies of critically ill patients who
received care in an intensive care unit. In contrast, cardiac
surgery-associated AKI and radiocontrast-induced AKI showed no sexual
dimorphism. Conclusion(s): Our meta-analysis contradicts the
established belief that female sex confers a greater risk of AKI and
instead suggests a protective role. Copyright © 2018 The
Author(s).

<51>
Accession Number
621323301
Title
Topical use of tranexamic acid in open heart surgery.
Source
Journal of the Pakistan Medical Association. 68 (4) (pp 538-542), 2018.
Date of Publication: April 2018.
Author
Chaudhary F.A.; Pervaz Z.; Ilyas S.; Niaz M.N.
Institution
(Chaudhary) Cardiothoracic Surgery, Rehmatul-lil-Alameen Institute of
Cardiology, PESSI, University of Lahore, Pakistan
(Pervaz) Cardiac Surgery, Sheikh Zayed Hospital, Lahore, Pakistan
(Ilyas) University of Lahore, Pakistan
(Niaz) Rehmatul-lil-Alameen Institute of Cardiology, PESSI, University of
Lahore, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: To determine the efficacy of topical pouring of tranexamic acid
in reducing post-operative mediastinal bleeding, requirement for blood
products and the rate of re-exploration for re-securing haemostasis or
relief of pericardial tamponade after open heart surgery. Method(s):
The prospective, randomised, placebo-controlled, double-blind comparative
study was conducted from March 2013 to September 2015 at
Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social
Security Institution, Lahore, and comprised patients scheduled for primary
isolated elective or urgent open heart surgery. The subjects were divided
into two equal groups. The hetranexamic acid group received cardiac bath
with 2gm of tranexamic acid diluted in 50mlof normal saline, while the
placebo group received cardiac bath without tranexamic acid. Before the
closure of sternum, the solution was poured into pericardial cavity as
cardiac bath while the chest tubes were temporarily clamped. Data was
entered into a pre-designed proforma. Result(s): Of the 100 subjects,
there were 50(50%) in each of the two groups. There was no difference in
surgical characteristics and perioperative complications in the groups
(p>0.05). After 48 post-operative hours, total blood loss was
significantly less in the tranexamic acid group compared to the placebo
group (p<0.05). Significantly less number of blood pints were transfused
in the acid group than the placebo group (p<0.05). No patient in the acid
group was re-explored for excessive bleeding compared to 4(8%) in the
placebo group. Conclusion(s): There was significant reduction in
post-operative blood drainage, need of blood products and rate of
re-exploration after topical use of tranexamic acid in open heart
surgery. Copyright © 2018, Pakistan Medical Association. All
rights reserved.

<52>
Accession Number
2000971783
Title
The effect of revascularization of a chronic total coronary occlusion on
electrocardiographic variables. A sub-study of the EXPLORE trial.
Source
Journal of Electrocardiology. 51 (5) (pp 906-912), 2018. Date of
Publication: September - October 2018.
Author
van Dongen I.M.; Kolk M.Z.H.; Elias J.; Meijborg V.M.F.; Coronel R.; de
Bakker J.M.T.; Claessen B.E.P.M.; Delewi R.; Ouweneel D.M.; Scheunhage
E.M.; van der Schaaf R.J.; Suttorp M.-J.; Bax M.; Marques K.M.; Postema
P.G.; Wilde A.A.M.; Henriques J.P.S.
Institution
(van Dongen, Kolk, Elias, Meijborg, Coronel, de Bakker, Claessen, Delewi,
Ouweneel, Scheunhage, Postema, Wilde, Henriques) Academic Medical Center -
University of Amsterdam, Amsterdam, Netherlands
(van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Suttorp) Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Bax) Haga Teaching Hospital, The Hague, Netherlands
(Marques) Free University Medical Center, Amsterdam, Netherlands
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Chronic total coronary occlusions (CTOs) have been
associated with a higher prevalence of ventricular arrhythmias compared to
patients without a CTO. We evaluated the effect of CTO revascularization
on electrocardiographic (ECG) variables. Method(s): We studied a
selection of ST-elevation myocardial infarction patients with a
concomitant CTO enrolled in the EXPLORE trial. ECG variables and cardiac
function were analysed at baseline and at 4 months follow-up.
 Result(s): Patients were randomized to percutaneous coronary
intervention (PCI) of their CTO (n = 77) or to no-CTO PCI (n = 81). At
follow-up, median QT dispersion was significantly lower in the CTO PCI
group compared to the no-CTO PCI group (46 ms [33-58] vs. 54 ms [37-68], P
= 0.043). No independent association was observed between ECG variables
and cardiac function. Conclusion(s): Revascularization of a CTO after
STEMI significantly shortened QT dispersion at 4 months follow-up. These
findings support the hypothesis that CTO revascularization reduces the
pro-arrhythmic substrate in CTO patients. Copyright © 2018

<53>
Accession Number
629041784
Title
Multiarterial coronary artery bypass grafting: is the radial artery
fulfilling the unkept promise of the right internal thoracic artery?.
Source
Current opinion in cardiology. 34 (6) (pp 628-636), 2019. Date of
Publication: 01 Nov 2019.
Author
Affronti A.; Ruel M.; Gaudino M.F.L.
Institution
(Affronti, Ruel) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York City, NY, United States
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: The debate on the second best conduit for CABG is still
intense. In this review, we discuss the role of the radial artery and the
right internal thoracic artery (RITA) compared with saphenous vein grafts
(SVG). RECENT FINDINGS: The recent RADIAL STUDY has been the first
evidence based on randomized trials of a clinical benefit using a second
arterial graft in CABG.On the other hand, the definitive 10-year results
of the ART trial failed to show a clinical advantage associated with the
use of bilateral internal thoracic artery (BITA). A thorough and
contextualized analysis of this and other studies, however, may offer a
different perspective. SUMMARY: Arterial conduits in CABG have shown
better patency rates than SVG. Whether this leads to better clinical
outcomes is still debated. In this setting, the radial artery and the RITA
seem to offer a similar advantage, although with different indications and
contraindications.

<54>
Accession Number
629280862
Title
What will surgical coronary revascularization look like in 25 years?.
Source
Current Opinion in Cardiology. (no pagination), 2019. Date of Publication:
2019.
Author
Caliskan E.; Emmert M.Y.; Falk V.
Institution
(Caliskan, Emmert, Falk) Department of Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Caliskan, Emmert, Falk) Department of Cardiothoracic and Vascular
Surgery, German Heart Institute Berlin, Berlin, Germany
(Falk) DZHK (German Centre for Cardiovascular Research), Partner Site
Berlin, Berlin, Germany
(Falk) Department of Health Sciences and Technology, ETH Zurich,
Translational Cardiovascular Technologies, Zurich, Switzerland
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review Coronary artery bypass grafting evolved in incremental
but significant steps since its introduction. Here, we provide an update
on operative techniques, choice of conduits, patient
selection/decision-making and primary and secondary prevention measures
with potential of influencing the future of coronary artery bypass
grafting (CABG) surgery. Recent findings Associated mortality of off-pump
CABG (OPCAB) procedures performed in high-volume OPCAB centers (>=164
cases per year) and by experienced surgeons (>=48 cases per year) was
reduced compared with on-pump CABG with two or more grafts suggesting a
volume-based dependency of outcomes in CABG procedures with high-technical
complexity. Ten-year results from the recent Arterial Revascularization
Trial showed no significant between-group difference for the primary and
secondary outcome. Total arterial revascularization using composite
bilateral internal mammary artery-Y-conduits through a limited access
mini-thoracotomy was not only shown to be feasible but a safe and
reproducible procedure with excellent midterm outcomes. The most recent
Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for
Coronary-Artery Bypass (REGROUP) trial demonstrated no significant
difference between open vein-graft harvesting and endoscopic vein-graft
harvesting in the occurrence of major adverse cardiac events. Summary
Adherence to the most recent guidelines on myocardial revascularization is
a key component for providing state-of the CABG surgery. Trends to lesser
invasiveness in surgical coronary revascularization will gain momentum and
is expected - with further improvements - to be the mainstay of future
surgical coronary revascularization strategies. Copyright © 2019
Wolters Kluwer Health, Inc.

<55>
Accession Number
628831824
Title
Transcatheter aortic valve implantation vs. surgical aortic valve
replacement for treatment of symptomatic severe aortic stenosis: an
updated meta-analysis.
Source
European heart journal. 40 (38) (pp 3143-3153), 2019. Date of Publication:
07 Oct 2019.
Author
Siontis G.C.M.; Overtchouk P.; Cahill T.J.; Modine T.; Prendergast B.;
Praz F.; Pilgrim T.; Petrinic T.; Nikolakopoulou A.; Salanti G.;
Sondergaard L.; Verma S.; Juni P.; Windecker S.
Institution
(Siontis, Overtchouk, Praz, Pilgrim, Windecker) Department of Cardiology,
Bern University Hospital, Inselspital, University of Bern, Bern,
Switzerland
(Cahill) Department of Cardiology, Oxford Heart Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Modine) Service de Chirurgie Cardiovasculaire, Hopital Cardiologique,
CHRU de Lille ,2 Av Oscar Lambret, Lille, France
(Prendergast) Department of Cardiology, St Thomas' Hospital ,Westminster
Bridge Rd, London, United Kingdom
(Petrinic) Cairns Library, Oxford University Hospitals NHS Foundation
Trust, Oxford, United Kingdom
(Nikolakopoulou, Salanti) Institute of Social and Preventive Medicine
(ISPM), University of Bern, Bern, Switzerland
(Sondergaard) Department of Cardiology, Heart Center, Rigshospitalet,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, ON, Toronto, Canada
(Juni) Department of Medicine and Institute of Health Policy, Management
and Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge
Institute of St Michael's Hospital, University of Toronto, 30 Bond Street,
Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
AIMS : Owing to new evidence from randomized controlled trials (RCTs) in
low-risk patients with severe aortic stenosis, we compared the collective
safety and efficacy of transcatheter aortic valve implantation (TAVI) vs.
surgical aortic valve replacement (SAVR) across the entire spectrum of
surgical risk patients. METHODS AND RESULTS : The meta-analysis is
registered with PROSPERO (CRD42016037273). We identified RCTs comparing
TAVI with SAVR in patients with severe aortic stenosis reporting at
different follow-up periods. We extracted trial, patient, intervention,
and outcome characteristics following predefined criteria. The primary
outcome was all-cause mortality up to 2years for the main analysis. Seven
trials that randomly assigned 8020 participants to TAVI (4014 patients)
and SAVR (4006 patients) were included. The combined mean STS score in the
TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low
surgical risk trials, respectively. Transcatheter aortic valve
implantation was associated with a significant reduction of all-cause
mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence
interval (CI) 0.78-0.99], P=0.030}; an effect that was consistent across
the entire spectrum of surgical risk (P-for-interaction=0.410) and
irrespective of type of transcatheter heart valve (THV) system
(P-for-interaction=0.674). Transcatheter aortic valve implantation
resulted in lower risk of strokes [HR 0.81 (95% CI 0.68-0.98), P=0.028].
Surgical aortic valve replacement was associated with a lower risk of
major vascular complications [HR 1.99 (95% CI 1.34-2.93), P=0.001] and
permanent pacemaker implantations [HR 2.27 (95% CI 1.47-3.64), P<0.001]
compared to TAVI. CONCLUSION : Compared with SAVR, TAVI is associated with
reduction in all-cause mortality and stroke up to 2years irrespective of
baseline surgical risk and type of THV system. Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. ©
The Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<56>
Accession Number
627951852
Title
Forced diuresis with matched hydration during transcatheter aortic valve
implantation for Reducing Acute Kidney Injury: a randomized,
sham-controlled study (REDUCE-AKI).
Source
European heart journal. 40 (38) (pp 3169-3178), 2019. Date of Publication:
07 Oct 2019.
Author
Arbel Y.; Ben-Assa E.; Puzhevsky D.; Litmanowicz B.; Galli N.; Chorin E.;
Halkin A.; Sadeh B.; Konigstein M.; Bassat O.K.-B.; Steinvil A.; Bazan S.;
Banai S.; Finkelstein A.
Institution
(Arbel, Ben-Assa, Puzhevsky, Litmanowicz, Galli, Chorin, Halkin, Sadeh,
Konigstein, Steinvil, Bazan, Banai, Finkelstein) Department of Cardiology,
Tel-Aviv Medical Center Affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, 6 weizman st ,Tel-Aviv, Israel
(Bassat) Department of Nephrology, Tel-Aviv Medical Center Affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, 6 weizman st
,Tel-Aviv, Israel
Publisher
NLM (Medline)
Abstract
AIMS: Acute kidney injury (AKI) is a common complication following
transcatheter aortic valve implantation (TAVI) and is associated with
increased risk for short- and long-term mortality. In patients undergoing
percutaneous coronary intervention (PCI), forced diuresis with matched
hydration has been shown to reduce the incidence of AKI by ~50%. The aim
of the present study was to evaluate whether forced diuresis with matched
intravenous hydration reduces AKI in patients undergoing TAVI. METHODS AND
RESULTS: Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre,
prospective, randomized, double-blind sham-controlled clinical trial,
designed to examine the effect of an automated matched saline infusion
with urine output for the prevention of AKI in patients undergoing TAVI. A
total of 136 TAVI patients were randomized, 68 in each group. Mean age was
83.9+/-5years and 41.2% were males. There were no differences in baseline
characteristics between the two groups. The rate of AKI was not
statistically different between the groups (25% in the active group vs.
19.1% in the sham group, P=0.408). There was a significant increase in
long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI
1.51-9.28; P=0.004). The study was terminated prematurely by the Data
Safety Monitoring Board for futility and a possible signal of harm.
 CONCLUSION(S): Unlike in PCI, forced diuresis with matched hydration
does not prevent AKI in patients undergoing TAVI, and might be associated
with increased long-term mortality. Future studies should focus on
understanding the mechanisms behind these findings. CLINICALTRIALS.GOV
REGISTRATION: NCT01866800, 30 April 2013. Copyright Published on
behalf of the European Society of Cardiology. All rights reserved. ©
The Author(s) 2019. For permissions, please email:
journals.permissions@oup.com.

<57>
Accession Number
2003128337
Title
Relation of Lipid-Lowering Therapy to Need for Aortic Valve Replacement in
Patients With Asymptomatic Mild to Moderate Aortic Stenosis.
Source
American Journal of Cardiology. (no pagination), 2019. Date of
Publication: 2019.
Author
Greve A.M.; Bang C.N.; Boman K.; Egstrup K.; Kesaniemi Y.A.; Ray S.;
Pedersen T.R.; Wachtell K.
Institution
(Greve) Department of Clinical Biochemistry, Rigshospitalet, Copenhagen,
Denmark
(Bang) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Boman) Department of Medicine, Institution of Public Health and Clinical
Medicine, Umea University, Skellefta, Sweden
(Egstrup) Medicinsk Afdeling, OUH Svendborg Sygehus, Denmark
(Kesaniemi) Department of Medicine, Institute of Clinical Medicine,
University of Oulu and Clinical Research Center, Oulu University Hospital,
Oulu, Finland
(Ray) Manchester Academic Health Sciences Center, University Hospitals of
South Manchester, Manchester, United Kingdom
(Pedersen) Center for Preventive medicine, Oslo University Hospital,
Ulleval and University of Oslo, Oslo, Norway
(Wachtell) Department of Cardiology, Oslo University Hospital, Oslo,
Norway
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In this study, we aimed to determine if pretreatment low-density
lipoprotein (LDL) levels and aortic stenosis (AS) severity alter the
efficacy of lipid-lowering therapy on reducing aortic valve replacement
(AVR). We used 1,687 patients with asymptomatic mild-to-moderate AS, who
were randomly assigned (1:1) to 40/10 mg simvastatin/ezetimibe combination
versus. placebo in the simvastatin and ezetimibe in aortic stenosis (SEAS)
trial. Pretreatment LDL levels (>4 mmol/L) and peak aortic jet velocity (3
m/s) were used to partition study participants into 4 groups, which were
followed for a primary endpoint of AVR. Cox regression with tests for
interaction was used to study the effect of randomized treatment in each
subgroup. During a median follow-up of 4.3 years (IQR 4.2 to 4.7 years;
total 7,396 patient-years of follow-up), 478 (28%) patients underwent AVR
and 146 (9%) died. A significant risk dependency was detected between
simvastatin/ezetimibe combination, LDL levels and mild versus moderate AS
on rates of AVR (p = 0.01 for interaction). In stratified analyses,
randomized treatment, therefore, reduced the rate of AVR in patients with
LDL levels >4 mmol and mild AS at baseline (HR 0.4; 95% CI: 0.2 to 0.9).
There was no detectable effect of randomized treatment on the need for AVR
in the 3 other participants subgroups. We conclude, that in a secondary
analysis from a prospective randomized clinical trial, treatment with
simvastatin/ezetimibe combination reduced the need for AVR in a subset of
patients with mild AS and high pretreatment LDL levels (Unique identifier
on clinicaltrials.gov: NCT00092677). Copyright © 2019 Elsevier
Inc.

<58>
Accession Number
2003273825
Title
Single- versus multidose cardioplegia in adult cardiac surgery patients: A
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.
Date of Publication: 2019.
Author
Gambardella I.; Gaudino M.F.L.; Antoniou G.A.; Rahouma M.; Worku B.;
Tranbaugh R.F.; Nappi F.; Girardi L.N.
Institution
(Gambardella, Gaudino, Rahouma, Worku, Tranbaugh, Girardi) Department of
Cardiothoracic Surgery, Weill Cornell Medicine-NewYork Presbyterian
Medical Center, New York, NY, United States
(Gambardella, Antoniou, Worku, Tranbaugh) Department of Cardiothoracic
Surgery, Weill Cornell Medicine-NewYork Presbyterian Brooklyn Methodist
Hospital, Brooklyn, NY, United States
(Antoniou) Department of Vascular & Endovascular Surgery, The Royal Oldham
Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
(Antoniou) Division of Cardiovascular Sciences, School of Medical
Sciences, University of Manchester, Manchester, United Kingdom
(Nappi) Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis,
Paris, France
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To compare outcomes of single (intervention group: del Nido
[DN], and histamine-tryptophan-ketoglutarate) versus multidose (control
group) cardioplegia in the adult cardiac surgery patients. Method(s):
Medical search engines were interrogated to identify relevant randomized
controlled trials and propensity-score matched cohorts. Meta-analysis was
conducted for primary (in-hospital/30-day mortality) and secondary
(ischemic and cardiopulmonary bypass [CPB] times, reperfusion
fibrillation, peak of cardiac enzymes, myocardial infarction) endpoints.
Subgroup analyses were conducted for study design and type of
intervention, and meta-regression for primary outcome included type of
surgery and left ventricular ejection fraction as moderators.
 Result(s): Ten randomized controlled trials and 13 propensity-score
matched cohorts were included, reporting on 5516 patients. Estimates are
expressed as (parameter value [OR, odds ratio; MD, mean difference; SMD,
standardized mean difference]/unit of measure [95% confidence interval], P
value). DN reduced ischemic time (MD, -7.18 minutes [-12.52 to -1.84], P <
.01), CPB time (MD, -10.44 minutes [-18.99 to -1.88], P .01), reperfusion
fibrillation (OR, 0.16 [0.05-0.54], P < .01), and cardiac enzymes (SMD
-0.17 [-0.29, 0.05], P < .01) compared with multidose cardioplegia. None
of these beneficial effects were reproduced by
histamine-tryptophan-ketoglutarate, which instead increased CPB time (MD,
2.04 minutes [0.73-3.37], P < .01) and reperfusion fibrillation (OR, 1.80
[1.20-2.70], P < .01). There was no difference in mortality and myocardial
infarction between single and multidose, independently of type of surgery
or left ventricular ejection fraction. Conclusion(s): DN decreases
operative times, reperfusion fibrillation, and surge of cardiac enzymes
compared with multidose cardioplegia. Copyright © 2019 The
American Association for Thoracic Surgery

<59>
Accession Number
2003291690
Title
MACHINE LEARNING TO FACILITATE ASSESSMENT OF DIASTOLIC FUNCTION BY
ECHOCARDIOGRAPHY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S4-S5), 2019. Date of
Publication: October 2019.
Author
Jiang R.; Yeung D.; Behnami D.; Jue J.; Tsang M.; Gin K.; Luong C.; Nair
P.; Girgis H.; Abolmaesumi P.; Tsang T.
Institution
(Jiang, Yeung, Behnami, Jue, Tsang, Gin, Luong, Nair, Girgis, Abolmaesumi,
Tsang) VancouverBritish ColumbiaCanada
Publisher
Elsevier Inc.
Abstract
Background: Echocardiographic assessment of diastolic function is complex
but has important diagnostic and prognostic implications in the management
of heart failure, particularly with preserved ejection fraction. The
updated 2016 ASE/EACVI Recommendations for the Evaluation of Left
Ventricular Diastolic Function by Echocardiography have proposed a less
complex diagnostic algorithm. However, it continues to rely on grading of
diastolic function based on category (normal, mild, moderate, severe,
indeterminate), which provides modest correlation with hemodynamic
measurements and remains echocardiographer-dependent. Whether machine
learning can be used to derive a more precise diastolic function score has
not been previously demonstrated. Methods and Results: We screened
224,026 consecutive studies performed at a tertiary care centre from Dec
30, 1999 to Dec 31, 2015. We excluded studies containing features that
preclude or complicate diastolic function assessment (stenotic, rheumatic
or prosthetic mitral valves; more than moderate mitral regurgitation or
MAC; non-sinus rhythm; confirmed or probable tamponade or constriction;
more than trivial pericardial effusion; congenital heart disease;
hypertrophic cardiomyopathy). We further excluded studies in which one or
more parameters deemed essential for diastolic function assessment (age,
EF, LAVi, TR velocity, E, lateral E', septal E', E/A, E/e') were not
reported. We graded diastolic function for the remaining studies based on
the ASE/EACVI 2016 diagnostic algorithm. Based on this grading, we trained
a fully-connected 4-layer neural network (Figure 1A), blinded to the
ASE/EACVI algorithm, to classify these studies by diastolic dysfunction
severity. We then changed the final layer to create a neural network that
would output a single continuous diastolic function score rather than a
discrete categorization into diastolic function severities (Figure 1B). A
total of 7,728 studies fulfilled inclusion and exclusion criteria. This
was split into training (80%) and validation (20%) datasets. Our neural
network reclassified the studies with 99.0% agreement to the ASE/EACVI
diastolic function grading when tested on the validation dataset (Figure
1C). We generated a novel continuous score corresponding to overall
diastolic function that corresponded well with diastolic function grading
using the ASE/EACVI guidelines (Figure 1D). Conclusion(s): To our
knowledge, this is the first study to use machine learning to generate a
continuous diastolic function score that corresponds well with current
recommendations of diastolic function grading. [Figure
presented] Copyright © 2019

<60>
Accession Number
2003291687
Title
SURGICAL ABLATION OF ATRIAL FIBRILLATION EVALUATION (SAFE): A COST
ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S143), 2019. Date of
Publication: October 2019.
Author
Chow J.; McClure G.; Belley-Cote E.; McIntyre W.; Singal R.; Whitlock R.
Institution
(Chow, McClure, Belley-Cote, McIntyre, Singal, Whitlock)
HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: International guidelines currently recommend concomitant
surgical ablation of atrial fibrillation (AF) in patients with known AF
undergoing cardiac surgery. However, a systematic review and meta-analysis
of 23 randomized controlled trials showed no significant difference in
mortality or stroke in patients who underwent surgical AF ablation
compared to those who did not. Methods and Results: We performed a
province-wide cost analysis of surgical AF ablation using data from a
systematic review and meta-analysis of randomized controlled trials, the
Cardiac Care Network (CCN) dataset from the Institute of Clinical
Evaluative Sciences, the ongoing LAAOS III trial (NCT01561651),
institutional costs from large academic centers in Ontario, as well as
professional fees based on the Ontario fee schedule. Device costs were
obtained from Canadian industry data. We found that the estimated average
extra cost of surgical AF ablation is $4269 CAD (95% CI $4097, $4598) per
patient. The majority of this is composed of procedural costs (82.3%),
while a smaller portion is related to the increased need for pacemaker
(3.9%) and increased hospital length of stay (13.8%). Based on the CCN
dataset and provincial fee codes, 2391 patients underwent surgical AF
ablation between 2006 and 2017, corresponding to an estimated $10.2
million in costs of surgical AF ablation during that time span.
 Conclusion(s): Ontario taxpayers spend significant financial
resources on surgical ablation of AF, a procedure that has not yet shown
benefit in reducing mortality or stroke. Further research examining
clinically important outcomes is needed to guide the allocation of scarce
funds to surgical AF ablation and to define its role in patient care.
[Figure presented] Copyright © 2019

<61>
Accession Number
2003291683
Title
INTRAVENOUS IRON FOR PRE-OPERATIVE ANEMIA IN CARDIAC SURGERY PATIENTS: A
PROMISING TREATMENT FOR A COMMON PROBLEM.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S192), 2019. Date of
Publication: October 2019.
Author
Gupta S.; Panchal P.; Pallo L.; Wilfred A.; Hou W.; Toor P.; Gilotra K.;
Whitlock R.; Belley-Cote E.
Institution
(Gupta, Panchal, Pallo, Wilfred, Hou, Toor, Gilotra, Whitlock,
Belley-Cote) HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Cardiac surgery patients with preoperative anemia are at
increased risk for mortality and morbidity. However, the benefits of
treating preoperative anemia with intravenous (IV) iron have not been
well-established. As such, we performed a systematic review and
meta-analysis to determine the effects of IV iron therapy in adult cardiac
surgery patients with preoperative anemia. Methods and Results: We
searched CENTRAL, MEDLINE and EMBASE for randomized controlled trials
(RCTs) and observational studies comparing IV iron therapy to
erythropoietin and/or oral iron or no therapy. We performed title and
abstract, full-text screening, data extraction, and risk of bias
assessment independently and in duplicate. We pooled data using a random
effects model in RevMan5.3, and evaluated the risk of bias for RCTs and
observational studies using the Cochrane and CLARITY tools, respectively.
We evaluated the overall quality of evidence with the GRADE framework. We
identified seven observational studies (n = 962) and four RCTs (n = 767)
meeting eligibility criteria. Pooled data from observational studies
demonstrated significant results in favour of IV iron therapy compared to
no therapy for all-cause mortality (relative risk (RR) 0.41, 95% CI [0.25
to 0.67], p=0.0005, I2=0%, very low quality), units transfused per patient
(MD -1.22, 95% CI [-1.85 to -0.60], p=0.0001, I2=0%, very low quality),
renal failure (RR 0.50, 95% CI [0.36 to 0.69], p < 0.0001, I2=0%, very low
quality), and hospital length of stay (mean difference (MD) 4.24, 95% CI
[-6.86 to -1.63], p=0.001, I2=0%, very low quality). Pooled data from RCTs
comparing IV iron therapy to oral iron therapy or no therapy demonstrated
significant results in favour of IV iron therapy for reducing the number
of patients transfused (RR 0.81, 95% CI [0.70 to 0.94], p=0.04 I2 = 26%,
moderate quality). The pooled results for hospital length of stay, units
transfused per patient, and renal failure from RCTs were consistent in
direction with the observational studies, but did not reach statistical
significance. Conclusion(s): The current body of evidence suggests
that IV iron therapy may improve postoperative mortality and morbidity in
adult cardiac surgery patients with preoperative anemia. However, these
findings are based on moderate quality of evidence. The results support
the need for a definitive randomized trial of IV iron in this
population. Copyright © 2019

<62>
Accession Number
2003291678
Title
AN ADAPTED CLAVIEN-DINDO CLASSIFICATION AND COMPREHENSIVE COMPLICATIONS
INDEX RELIABLY REPRESENT EARLY POSTOPERATIVE OUTCOMES IN CARDIAC SURGERY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S165), 2019. Date of
Publication: October 2019.
Author
Hebert M.; Cartier R.; El-Hamamsy I.; Dagenais F.; Langlois Y.; de
Varennes B.; Greentree D.; Stevens L.
Institution
(Hebert, Cartier, El-Hamamsy, Dagenais, Langlois, de Varennes, Greentree,
Stevens) MontrealQuebecCanada
Publisher
Elsevier Inc.
Abstract
Background: Cardiac surgery lacks a uniform method for reporting
postoperative morbidities, limiting the comparison of studies and
meta-analyses. In other surgical specialties, the Clavien-Dindo
classification (CDC) was successfully implemented as an outcome reporting
method with an equally promising derivative, the Comprehensive
Complications Index (CCI). This study aims to verify whether these
classifications accurately represent the complexity of postoperative
outcomes in cardiac surgery. Methods and Results: Data on 38,257
adult patients who underwent cardiac surgery at six university hospitals
between October 2010 and December 2018 was prospectively collected in a
provincial clinical database. Adaptations to the CDC were made for
medically treated complications in cardiac surgery requiring
antiarrhythmics, vasopressors, and transfusion of 1 or 2 units of blood,
which were recoded as grade I complications. Postoperative complications
until hospital discharge were recoded using the associated CDC grade as
determined by an expert consensus of attending cardiac surgeons, and the
CCI was calculated. Spearman's rho was performed to evaluate correlations
between the CDC and CCI with hospital stay, ICU stay, and surgery times.
In this cohort (73% men, mean age 67+/-11 years), 72% of patients
underwent coronary artery bypass graft surgery and/or valve surgery in 41%
of patients. Other operations constituted 12% of cases. Median hospital
stay was 6 days [Q1, Q3: 5, 9], while ICU stay was 2 days [1, 3]. The CDC
grading was: none in 22.5%, grade I in 26.5%, grade II in 24.1%, grade
IIIa in 7.1%, grade IIIb in 1.5%, grade IVa in 13.6%, grade IVb in 1.6%,
and grade V in 3.1%. Median CCI was 21 [9, 34]. Only 6 patients (0.016%)
had a score superior to 100. The CDC and CCI had a correlation of 0.976.
When removing cases of patient deaths, the CDC and CCI correlated with ICU
stay by 0.474 and 0.517 (p < 0.001), respectively, whereas correlations
with hospital LOS were 0.577 and 0.620 (p < 0.001), respectively. The CDC
and CCI also positively correlated with surgery duration (0.243 and 0.254,
p < 0.001), cardiopulmonary bypass time (0.247 and 0.263, p < 0.001), and
cross-clamp time (0.203 and 0.218, p < 0.001). Conclusion(s): The CDC
and CCI strongly correlated with hospital and ICU stay. They also
correlated with surgery times, suggesting that longer, more complex
operations are associated with increased incidence of postoperative
complications. This adapted version of the CDC accurately reflects the
complex postoperative course of adult cardiac surgery patients with one
simple scale and has direct, useful applications to outcome reporting and
quality improvement initiatives. Copyright © 2019

<63>
Accession Number
2003291613
Title
OUTCOMES SUTURELESS AORTIC VALVE REPLACEMENT VERSUS CONVENTIONAL AORTIC
VALVE REPLACEMENT AND TRANSCATHETER AORTIC VALVE REPLACEMENT: A SYSTEMATIC
REVIEW AND META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S91-S92), 2019. Date of
Publication: October 2019.
Author
Makhdoum A.; Gupta S.; Alsagheir A.; Pandey A.; Um K.; Yanagawa B.; Teoh
K.; Whitlock R.; Belley-Cote E.
Institution
(Makhdoum, Gupta, Alsagheir, Pandey, Um, Yanagawa, Teoh, Whitlock,
Belley-Cote) TorontoOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Sutureless aortic valve replacement (SuaVR) is a feasible
alternative to conventional aortic replacement (SAVR) and transcatheter
aortic valve replacement (TAVR). The aim of this study is to compare the
effectiveness of the SuAVR versus SAVR, and SuAVR versus TAVR.
 Methods and Results: We searched MEDLINE and EMBASE from inception to
August 2018 for adjusted observational studies evaluating SuAVR, SAVR, and
TAVR in adult patients with aortic stenosis. Independently and in
duplicate, we performed screening, full-text assessment, risk of bias
evaluation using the CLARITY tool. We pooled data using a random-effects
model. We evaluated the quality of evidence using the GRADE framework. Of
the references, 34 studies including 7979 participants (SuAVR versus SAVR=
6831; SuAVR versus TAVR= 1148) conducted between 2012 and 2018 were
included. Overall, studies were judged to be at unclear risk of bias.
Compared to SAVR and TAVR, SuAVR was associated with similar postoperative
mean transvalvular gradients (mean difference]MD [: -1.00; 95% CI, -2.76
to 0.76; P=0.27) and (MD: 0.50; 95% CI, 0.27 to 1.28; P=0.20)
respectively. Compared to TAVR, SuAVR showed a reduction in mortality at
30 days (odds ratio (OR): 0.36; 95% CI, 0.17 to 0.73; P=0.005) and 2 years
(OR: 0.39, 95 CI, 0.17 to 0.88; P=0.003). Reduction in mortality did not
reach statistical significance in high risk (OR:0.16, 95% CI, 0.02 to
1.35; P=0.09) or intermediate risk patients (OR: 0.76, 95% CI, 0.32 to
1.82, P=0.54). Compared to TAVR, SuAVR showed reduction in mild (OR: 0.09,
95% CI, 0.03 to 0.26, P=0.000) and moderate paravalvular leaks (OR: 0.11,
95% CI, 0.02 to 0.61, P=0.01). Moreover, SuAVR showed significant
reduction in acute kidney injury compared to TAVR (OR: 0.50, 95 % CI, 0.27
to 0.91, P=0.02) and comparable reduction to SAVR (OR: 0.89, 95% CI, 0.45
to 1.76, P=0.47). Compared to SAVR, SuAVR showed a similar reduction in
mortality at 30 days (OR: 1.01, 95 % CI, 0.72 to 1.42, P=0.93) and at 2
years (OR: 0.99, 95 % CI, 0.43 to 2.30, P= 0.30). These results were rated
low-quality evidence using the GRADE framework. Conclusion(s): While
the use of sutureless aortic valves is increasing with similar short and
midterm outcomes compared to TAVR and SAVR, the quality of evidence
supporting its utilization is low, even with matched patients. Comparative
randomized data with long-term follow up is required to elucidate the role
of SuAVR. [Figure presented] [Figure presented] Copyright © 2019

<64>
Accession Number
2003291599
Title
EVOLUTION OF TRANSVALVULAR GRADIENTS AFTER TAVR ACCORDING TO USE OF
ANTICOAGULATION THERAPY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S36-S37), 2019. Date of
Publication: October 2019.
Author
Bisson J.; Daneault B.
Institution
(Bisson, Daneault) MontrealQuebecCanada
Publisher
Elsevier Inc.
Abstract
Background: Most current guidelines have weak recommendations for short
term dual antiplatelet therapy (DAPT) use after transcatheter aortic valve
replacement (TAVR). There also has been growing interest for
anticoagulation therapy after TAVR, but it's role remains a subject of
debate. Some authors have suggested that anticoagulation post TAVR might
prevent both clinical and subclinical thrombosis of the prosthetic valve.
Yet, there is little data on anticoagulation and its impact on the valve's
long-term hemodynamics, with hemodynamic deterioration remaining of
uncertain clinical significance. This study aimed to compare the evolution
of transvalvular gradients and aortic valvular area (AVA) post TAVR
according to use of anticoagulation therapy. Methods and Results:
This monocentric retrospective study included 128 patients who underwent
TAVR at the Centre hospitalier universitaire de Sherbrooke between 2011
and 2018. Anticoagulation was prescribed at discharge after TAVR in a
total of 52 patients (41%), and 76 patients (59%) were left on
antiplatelet therapy alone. All available follow-up echocardiographic data
was analyzed, and mixed linear models were used to compare the evolution
of transvalvular gradients and AVA between the two groups. A total of 439
echocardiograms, over a median follow-up of 18 months (1 to 78 months),
were included for analysis. Secondary outcomes included ischemic events,
bleeding, and rehospitalization at one year. Anticoagulated patients had
more atrial fibrillation (88.5 vs 2.6%, p < 0.0001), including permanent
AF (62.7 vs 1.3%), and a smaller baseline mean aortic gradient (38.3 vs
46.5 mmHg, p = 0.002). The evolution of the mean aortic gradient over time
did not significantly differ in time between the two groups (p=0.85). The
mean aortic gradient was significantly higher in the non-anticoagulated
group (p = 0.03), but this difference was noted from baseline and was
constant throughout follow-up. The mean aortic gradient increased
significantly in time in both groups. The AVA (p = 0.98) or its evolution
in time (p = 0.47) did not differ significantly between the two groups. It
also did not significantly change in time for neither the anticoagulation
of non-anticoagulated groups. No significant difference was found with
regards to secondary outcomes. Conclusion(s): In this study,
anticoagulation after TAVR was not associated with slower hemodynamic
deterioration of the prosthetic valve. Anticoagulated patients had lower
transvalvular gradients, but similar AVA. This could be the reflect of
lower flow in anticoagulated patients, of which almost two thirds had
permanent AF. Randomized trials are needed to further understand the role
of anticoagulation after TAVR. [Figure presented] [Figure
presented] Copyright © 2019

<65>
Accession Number
2003291585
Title
BARIATRIC SURGERY IN MORBIDLY OBESE PATIENTS WITH END STAGE HEART FAILURE
AS A BRIDGE TO HEART TRANSPLANTATION: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S14-S15), 2019. Date of
Publication: October 2019.
Author
Lee Y.; Anvari S.; Doumouras A.; Wong J.; Gmora S.; Anvari M.; Hong D.
Institution
(Lee, Anvari, Doumouras, Wong, Gmora, Anvari, Hong) HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: In patients with end stage heart failure (ESHF), heart
transplantation greatly improves survival. However, class 2 obesity or
higher (body mass index (BMI) > 35 kg/m2) is a relative
contraindication. Bariatric surgery has been explored as a potential
bridging procedure to heart transplant, both by facilitating weight loss
and improving cardiac function. The aim of this systematic review and
meta-analysis is to investigate the safety and efficacy of bariatric
surgery in achieving weight loss and improving transplant candidacy in
patients with ESHF. Methods and Results: MEDLINE, EMBASE, CENTRAL,
and PubMed databases were searched up to February 2019 for studies that
performed bariatric surgery on patients with morbid obesity (BMI >40
kg/m2 or BMI >35 kg/m2 with comorbidities) and ESHF.
Key outcomes included rate of patients listed for heart transplantation
after bariatric surgery, rate of patients subsequently receiving
transplant, change in BMI after bariatric surgery, 30-day mortality, and
30-day complications. Pooled estimates were calculated using the random
effects meta-analysis of proportions. Methodological Index for
Non-Randomized Studies (MINORS) tool was used to assess quality of
evidence. From 2,058 potentially eligible studies, 10 studies with 92
patients were included, all of which were non-randomized, single arm
studies. The median (range) age of patients at the time of surgery was
43.5 (34-51) years with 40.8% being female. Causes of ESHF were
non-ischemic cardiomyopathy (58.7%), ischemic cardiomyopathy (27.1%), and
others (14.3%). 95.7% of patients had a left-ventricular assist device
(LVAD) inserted before bariatric surgery and 4.3% of the patients had LVAD
inserted at the time of bariatric surgery. Mean (SD) preoperative BMI was
45.1 (5.1) kg/m2 and BMI after surgery was 33.8 (4.0)
kg/m2 with absolute BMI loss of 25.1%. After bariatric surgery,
69% (95% CI, 48%-88%) of patients with ESHF were listed for
transplantation. Time to bariatric surgery to receiving heart transplant
was 12 (13-20.5) months. Of the listed patients, 67% (95% CI, 45-86%)
successfully received heart transplant. The rate of 30-day bariatric
surgery-related complications was 18% (95% CI 6%-33%) and rate of 30-day
mortality after bariatric surgery was 0%. Conclusion(s): Bariatric
surgery can facilitate sustained weight loss in morbidly obese patients
with ESHF, thus improving heart transplant candidacy and transplantation.
However, data on long-term heart transplant outcomes in this population is
limited. Copyright © 2019

<66>
Accession Number
2003291577
Title
PICK YOUR CONDUIT WISELY TO DECREASE GRAFT FAILURE AFTER CABG SURGERY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S163), 2019. Date of
Publication: October 2019.
Author
Alboom M.; Browne A.; Dagenais F.; Noiseux N.; Kieser T.; Legare J.; Brown
C.; Kiaii B.; Eikelboom J.; Lamy A.
Institution
(Alboom, Browne, Dagenais, Noiseux, Kieser, Legare, Brown, Kiaii,
Eikelboom, Lamy) HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: There is a lack of evidence for choosing the second conduits
in coronary artery bypass grafting (CABG) surgery as surgical
characteristics that influence graft failure are still uncertain. This
study describes the graft patency of the left internal mammary artery
(LIMA), radial artery (RA), saphenous vein (SV), and right internal
mammary artery (RIMA) 1 year after CABG surgery. Methods and Results:
This substudy randomized 1,448 COMPASS trial patients 4 to 14 days after
CABG surgery to receive the combination of rivaroxaban plus aspirin,
rivaroxaban alone, or aspirin alone. Overall, 1,448 patients (3,460
grafts) were recruited from 78 centers in 22 countries that were included
in our graft-level analysis. Grafts were categorized by quality (conduit
and target vessel), location (proximal and distal sites) and percentage of
target vessel stenosis. We defined graft failure to include all grafts
with string sign in addition to those that had completely occluded. There
were no differences in rates of graft failure between drug treatment
groups as diagnosed by computed tomography (CT) angiogram 1 year after
CABG surgery. Failure of LIMA grafts were infrequent at 6.4% (69/1065
patients, 95% CI 5.1-8.1%) and depended on the quality of the conduit but
not on the quality of distal target territory. The RA had an overall rate
of graft failure of 9.9% (9/91, 95% CI 5.1-17.9%) and its failure was
associated with the percentage of target vessel stenosis. The overall rate
of graft failure of the SV conduit was 10% (222/2221, 95% CI 8.8-11.8%)
and its failure was independent of the quality of the conduit or the
percentage of target vessel stenosis. The overall failure rate of RIMA
grafts was 21.7% (18/83, 95% CI 14.1-31.8%) but with unacceptably high
rate of graft failure 65% (11/17, 95% CI 41-83%) when directly anastomosed
to the left circumflex territory with a posterior cardiac approach but
with a lower rate of graft failure 23% (3/13, 95% CI 7.5-50.9%) when used
as a free graft/piggyback anastomosed to the left circumflex territory.
 Conclusion(s): The LIMA is the first choice conduit unless it is of
poor quality. The RA is an excellent second conduit unless the proximal
target vessel stenosis is less than 80%. SV grafts perform well in all
situations and are excellent choice for a second or third conduit. RIMA
directly anastomosed to the left circumflex territory had an unacceptably
high graft failure rate. Copyright © 2019

<67>
Accession Number
2003291527
Title
IS THE ROSS PROCEDURE A COST-EFFECTIVE ALTERNATIVE COMPARED TO MECHANICAL
AORTIC VALVE REPLACEMENT IN NON-ELDERLY PATIENTS WITH AORTIC STENOSIS?.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S167), 2019. Date of
Publication: October 2019.
Author
Hussain S.; Tong W.; Whitlock R.; Belley-Cote E.; McClure G.; Sibilio S.;
Tarride J.; Lamy A.
Institution
(Hussain, Tong, Whitlock, Belley-Cote, McClure, Sibilio, Tarride, Lamy)
HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Controversy exists when managing young patients with aortic
valve stenosis. Aortic valve replacement (AVR) with a mechanical
prosthesis requires long-term anticoagulation and patients have an
increased risk of thromboembolism and bleeding. The Ross procedure is
proposed as an alternative, but it is associated with higher procedure
costs and increased risk of cardiac re-interventions. We sought to
determine the incremental cost per life year gained between the Ross
procedure and mechanical AVR in patients under 55 years old with aortic
stenosis. Methods and Results: A Markov model with 1-year cycles was
developed to determine the long-term costs and benefits associated with
the Ross procedure and mechanical AVR in this patient group. The model
included 5 health states: well/no complication, major bleeding,
thromboembolism, cardiac re-intervention, and death. The start time of the
model was the average age at the index surgery (40 years old) and
continued for a time horizon of 40 years. Transition probabilities between
health states were obtained from meta-analyses on Ross procedure (63
studies) and mechanical AVR (27 studies) outcomes. Costs were obtained
from literature, Ontario Health Insurance Plan billing, and our
institution. Benefits were expressed in terms of life years (LYs). A
discount rate of 1.5% was applied for future costs and benefits and the
analyses were conducted from a third-party payer perspective. Univariate
sensitivity analysis was conducted by varying the risks of
thromboembolism, cardiac re-intervention, time horizon, cost of the Ross
procedure, and discount rate. A probabilistic analysis using Monte Carlo
simulations was conducted to deal with model parameter uncertainty.
 Result(s): The incremental life years gained is 2.87 years in favour
of the Ross procedure, with an associated incremental cost of $5,888.86,
yielding an ICER of $2,051.87 per life year gained. The biggest
determinants of cost-effectiveness were the rate of re-interventions in
the Ross group and risk of thromboembolism (stroke) in the mechanical AVR
group. The Ross procedure was always cost-effective at a willingness to
pay threshold of $50,000 per life year gained. Conclusion(s): Our
results indicate that the Ross procedure is a cost-effective alternative
in comparison to mechanical AVR in non-elderly patients with aortic
stenosis. However, the current body of evidence is highly subjected to
expertise and publication bias. Additional data is required from a well
conducted large randomized control trial for more accurate conclusions.
Results from this economic evaluation can inform policy makers and future
cardiac surgery guidelines. [Figure presented] Copyright © 2019

<68>
Accession Number
2003291510
Title
ANTI-PLATELET THERAPY AFTER CORONARY ARTERY BYPASS GRAFTING: A SYSTEMATIC
REVIEW AND NETWORK META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S195), 2019. Date of
Publication: October 2019.
Author
Gupta S.; Panchal P.; Pandey A.; Basha A.; Pallo L.; Bozzo A.; Belley-Cote
E.; Whitlock R.
Institution
(Gupta, Panchal, Pandey, Basha, Pallo, Bozzo, Belley-Cote, Whitlock)
HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Aspirin (ASA) monotherapy is the standard of care after
coronary artery bypass grafting (CABG), but the benefits of more intense
antiplatelet therapy, specifically dual antiplatelet therapy (DAPT), has
not been well-established in all CABG patients. We performed a network
meta-analysis (NMA) to compare the effects of various antiplatelet therapy
regimens on saphenous vein graft (SVG) patency, all-cause mortality, and
bleeding outcomes amongst adult patients following CABG. Methods and
Results: We searched CENTRAL, MEDLINE, EMBASE, CINAHL ACPJC and grey
literature sources (AHA, ACC, ESC and CCC conference proceedings, ISRCTN
Register, and WHO ICTRP) for randomized controlled trials (RCTs) which fit
our criteria. Screening, data extraction, risk of bias (ROB) and GRADE
were performed in duplicate. The NMA was performed with R, the results
reported as odds ratios, and the I2 value was reported for heterogeneity.
We used the surface under the cumulative ranking curve (SUCRA) to estimate
the ranking of interventions. We included 41 RCTs comprising 14,014
patients. For reduction in SVG stenosis and obstruction at one-year,
therapy with ASA and ticagrelor ranked first. Compared to ASA monotherapy,
DAPT with ASA and ticagrelor statistically significantly reduced stenosis
(odds ratio [OR] 0.41, 95% credible interval [CrI]: 0.25,0.70). For
reduction in all-cause mortality at one-year, monotherapy with clopidogrel
was ranked first. Compared to ASA only, clopidogrel statistically
significantly reduced mortality (OR 2.0e-09, 95%CrI: 2.7e-26, 1.0).
Meanwhile, DAPT with ASA and ticagrelor demonstrated a direction towards
lower all-cause mortality at one-year (OR 0.38, 95%CrI: 0.013, 5.8) when
compared to ASA monotherapy, but failed to reach statistical significance.
For major bleeding events at one-year, placebo or no antiplatelet therapy
ranked first. However, compared to standard of care (ASA monotherapy),
DAPT with ASA and ticagrelor or ASA and clopidogrel was not associated
with a statistically significant increase in bleeding. Heterogeneity for
SVG stenosis, and bleeding was low (I2 <=25%), and high for mortality (I2
>50%). Conclusion(s): Our work is the largest and most comprehensive
quantitative synthesis of RCT data regarding the use of antiplatelet
therapy following coronary artery bypass grafting surgery. The network
ranked ASA and ticagrelor first for SVG patency, and demonstrated no
statistically significantly higher bleeding events compared to other
antiplatelet regimens. [Figure presented] Copyright © 2019

<69>
Accession Number
2003291461
Title
A SURVEY OF CARDIAC SURGEONS TO EVALUATE THE USE OF SUTURELESS AORTIC
VALVE REPLACEMENT IN CANADA.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S92), 2019. Date of
Publication: October 2019.
Author
Makhdoum A.; Koziarz A.; Alsagheir A.; Reza S.; Yanagawa B.; Teoh K.;
Belley-Cote E.; Whitlock R.
Institution
(Makhdoum, Koziarz, Alsagheir, Reza, Yanagawa, Teoh, Belley-Cote,
Whitlock) TorontoOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Sutureless aortic valve replacement (SuAVR) is gaining
popularity for the treatment of aortic stenosis. The advantages of SuAVR
over conventional AVR include shorter operative time and easier deployment
during minimally invasive procedures. We sought to establish practice
patterns and perceptions regarding SuAVR of cardiac surgeons in Canada.
 Methods and Results: A surgeon survey was developed by established
content experts, including cardiac surgeons, cardiologists and
methodologists. The survey was administered electronically. Five
clinicians piloted the survey for clarity and length. The questionnaire
examined several domains including respondent characteristics, factors
influencing the decision to implant a SuAVR, barriers to SuAVR use, and
interest in participating in a trial. We received responses from 66 of 79
surgeons surveyed (84% response rate), representing 18 hospitals across
Canada. Every surgeon surveyed had performed at least 1 SuAVR
implantation. Respondents were in independent practice for median of 15
(8-20) years. As per surgeons routine practice, 54% performed SuAVRs, and
32% performed SuAVR and TAVR; 14% did not perform SuAVR. When asked which
factors guided the decision to perform SuAVR included, 73% indicated
"hostile root", 55% indicated small annular size, 42% chose high STS
score, 40% chose older age, 25% selected minimally invasive approach, and
23% selected redo-operation. Factors reported to be against implanting
SuAVR were young age (73%), low STS score (40%), and large annular size
(30%). Respondents felt that barriers to the use of SuAVR included the
cost of the device (33%), risk of permanent pacemaker (27%) and durability
(12%). The majority of respondents were interested in participating in a
randomized controlled trial comparing SuAVR with TAVI (73%).
 Conclusion(s): Surgeons reported being more likely to use a SuAVR in
patients with high surgical risk, older age, hostile root,
redo-operations, and a small annulus. Cost is the main factor limiting
SuAVR use in Canada. The surgical community is interested in trial
comparing SuAVR with TAVI. These findings will inform the design of this
trial. [Figure presented] Copyright © 2019

<70>
Accession Number
2003291392
Title
RE-EXPLORATION AND ECONOMIC JUSTIFICATION OF A CHEST DRAINAGE PROTOCOL
IMPLEMENTING ACTIVE TUBE CLEARANCE AFTER CARDIAC SURGERY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S189-S190), 2019. Date of
Publication: October 2019.
Author
St-Onge S.; Bouhout I.; Bouchard D.; Carrier M.; Cartier R.; El-Hamamsy
I.; Jeanmart H.; Lamarche Y.; Pellerin M.; Perrault L.; Demers P.
Institution
(St-Onge, Bouhout, Bouchard, Carrier, Cartier, El-Hamamsy, Jeanmart,
Lamarche, Pellerin, Perrault, Demers) MontrealQuebecCanada
Publisher
Elsevier Inc.
Abstract
Background: Appropriate evacuation of shed blood with chest tubes is a
critical component of patient care after cardiac surgery as re-exploration
for bleeding or tamponade is a morbid, lethal and costly complication.
Drainage protocols involving extended drainage duration, specific
placement of silastic drains or prevention of intraluminal clogging have
all exhibited the potential to reduce the need for re-exploration. This
sub-study from a larger randomized investigation is aimed towards
exploring the risk factors and impacts of re-exploration, while also
determining whether the implementation of active chest tube clearing
devices is economically justified. Methods and Results: Data from the
490 patients included in the analysis by intention-to-treat of our
pragmatic, single-blinded, parallel randomized control trial comparing a
chest drainage strategy using active tube clearance (ATC) at the bedside
to standard management after cardiac surgery in two centers affiliated to
the Universite de Montreal School of Medicine, were used. The 18 patients
who required re-exploration for bleeding or tamponade were compared with
the ones who did not experience such complication through univariate
analysis (chi-square, Fischer exact, t-test and Mann-Whitney U tests were
used appropriately). A cost-benefit analysis was also conducted. Patients
who required re-exploration presented more preoperative pulmonary
hypertension (33% vs 9%, P = 0.01) and higher EuroScore II (3.54 +/- 3.55%
vs 2.30 +/- 2.28%, P = 0.03). Mitral valve replacements or repairs (11% vs
2%, P = 0.02) and aortic surgeries (11% vs 1%, P = 0.02) were more
frequent in the re-exploration group. The incidence of POAF (83% vs 34%, P
< 0.001) and allogenic blood products transfusion (89% vs 32%, P < 0.001)
were higher in the re-exploration group. Re-exploration was associated
with significantly greater in-hospital mortality (22% vs 1%, P < 0.001),
increased rate of acute renal failure and cardiac arrest, and longer
ventilation time, intensive care unit time and hospital length of stay. In
our randomized controlled trial, ATC was associated with a significant
reduction in re-exploration, with a Number Needed to Treat of 25. The
cost-benefit analysis, based on mean local incremental costs per major
complication, which includes re-exploration, revealed savings of ~240$ per
patients by systematically using ATC. Conclusion(s): Re-exploration
after cardiac surgery is associated with significantly worse outcomes and
potentially lethal complications. While determining which patient will
require re-exploration after cardiac surgery may be delicate, the
implementation of a drainage strategy using ATC could represent an
efficient and cost-effective preventative strategy. Copyright ©
2019

<71>
Accession Number
2003291366
Title
THE SKELETON IN THE CLOSET: HIGHER RATES OF GRAFT FAILURE AT 1 YEAR IN THE
SKELETONIZED VERSUS PEDICLED INTERNAL MAMMARY ARTERY.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S146-S147), 2019. Date of
Publication: October 2019.
Author
Alboom M.; Browne A.; Dagenais F.; Noiseux N.; Kieser T.; Legare J.; Brown
C.; Kiaii B.; Eikelboom J.; Lamy A.
Institution
(Alboom, Browne, Dagenais, Noiseux, Kieser, Legare, Brown, Kiaii,
Eikelboom, Lamy) HamiltonOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Internal mammary arteries (IMA) are routinely used as conduits
in CABG surgery given their superior long-term patency rates and high
resistance to atherosclerosis. These conduits can be harvested pedicled,
whereby the IMA is dissected along with its surrounding fascia including
blood and nerve supplies (i.e. preserving the milieu of the conduit) or
skeletonized, whereby the IMA is dissected from its surrounding blood
supply, innervation, lymphatics, muscle and fascia (i.e. preserving the
milieu of the sternum). Despite the positive effects of skeletonization on
graft length and sternal wound infections, few prospective studies have
examined the effect of that harvesting technique on angiographic endpoints
and therefore it remains unclear whether skeletonization adversely affects
the risk of graft failure. Methods and Results: We conducted a
substudy of 1,448 COMPASS trail patients randomized 4 to 14 days after
CABG surgery to receive rivaroxaban, aspirin, or both and underwent a
follow-up CT angiogram after 1 year. Graft failure was diagnosed by CT
angiogram and included grafts with string signs in addition to complete
occlusion. We present an analysis of 1,066 IMA grafts grafts examining the
impact of graft harvesting technique (pedicled vs. skeletonized) on graft
failure 1 year after CABG surgery. Baseline characteristics of the 3
treatment groups were similar and no differences in graft failure rates
were observed between drug treatments. The rate of graft failure was 6.1%
(46/752) in the pedicled IMA group versus 12.4% (39/314) in the
skeletonized IMA group (odds ratio 2.18; 95% CI 1.39 to 3.41; P < 0.001).
Similarly, in pedicled left-IMA (LIMA) the rate of graft failure was 5.4%
compared to 9.6% in skeletonized LIMA grafts (odds ratio 1.87; 95% CI 1.11
to 3.13; P=0.02). A trend of graft failure was observed as well between
pedicled (23.3%; 7/30) and skeletonized (29.5%; 13/44) in right-IMA (RIMA)
grafts (odds ratio 1.38; 95% CI 0.48 to 4.00; P=0.55). Conclusion(s):
The skeletonized harvesting technique is associated with a significant
increase in IMA graft failure 1 year after CABG surgery compared to the
pedicled technique. Further investigation of the impact of the
skeletonized technique on the risk of graft failure is warranted before
advocating for its widespread use. Copyright © 2019

<72>
Accession Number
2003291297
Title
RISK PREDICTION MODELS FOR SURVIVAL AFTER HEART TRANSPLANTATION: A
SYSTEMATIC REVIEW.
Source
Canadian Journal of Cardiology. Conference: Canadian Cardiovascular
Congress 2019. Canada. 35 (10 Supplement) (pp S94-S95), 2019. Date of
Publication: October 2019.
Author
Aleksova N.; Alba A.; Molinero V.; Connolly K.; Orchanian-Cheff A.;
Badiwala M.; Ross H.; Posada J.D.
Institution
(Aleksova, Alba, Molinero, Connolly, Orchanian-Cheff, Badiwala, Ross,
Posada) TorontoOntarioCanada
Publisher
Elsevier Inc.
Abstract
Background: Several risk prediction scores have been used to assess short
and long-term survival following heart transplantation (HT). Unlike other
organ sharing allocation programs, no single score has been widely
accepted in HT. Our objective was to systematically review the model
characteristics and performance for all available scores that predict
survival after HT. Methods and Results: Ovid Medline, Ovid MEDLINE
Epub Ahead of Print and In-Process & Other Non-Indexed Citations, Ovid
Embase, Cochrane Database of Systematic Reviews, and Cochrane Central
Register of Controlled Clinical Trials were searched to December 2018.
Eligible articles reported a score or formula to predict mortality
following HT in adults. Data extraction and study quality were assessed
using the TRIPOD (Transparent Reporting of studies on prediction models
for Individual Prognosis or Diagnosis) reporting guidelines. Of the 5392
studies screened, 31 studies were included that evaluated 21 scores
(Figure). There were 14 novel HT-specific scores (of which 6 were
validated in external cohorts), and 7 scores developed in non-HT
populations that were validated in external cohorts. There were 26 donor
and 39 recipient predictors identified in the 14 novel HT-specific scores.
Age and ischemic time were the most common donor predictors, found in 10
and 8 scores respectively. Five recipient predictors were common to at
least 9 scores: age, renal function, total bilirubin, mechanical
ventilation and temporary mechanical circulatory support. Of 21 scores, 11
(52%) assessed for calibration and 15 (71%) reported discrimination
(Table). Overall model discrimination for HT-specific scores ranged from
poor to moderate (C-index or AUROC 0.48-0.77). The Index for Mortality
Prediction after Cardiac Transplantation (IMPACT) score was the most
widely validated, was well calibrated in two large registries, but had
best discrimination for short-term mortality in single centre studies. The
Model for End Stage Liver Disease (MELD) had very good discrimination
(AUROC 0.825-0.997) based on performance in 155 patients.
 Conclusion(s): None of the HT-specific scores performed particularly
well in any cohort in which they were assessed. Of non-HT specific scores,
MELD showed good model performance in only a small cohort of patients.
This systematic review strongly supports the need for prospective models
derived from contemporary candidates, including donor and recipient
factors, and focusing on short-term outcomes. Models to predict
longer-term outcomes should incorporate post-HT factors to improve their
performance. [Figure presented] [Figure presented] Copyright ©
2019

<73>
Accession Number
2002174192
Title
3. Cardiac tamponade in echocardiography, prevalence and causes in the
adult population at King Abdul Aziz Medical City, Riyadh.
Source
Journal of the Saudi Heart Association. Conference: SHA 30 Meeting Oral.
Saudi Arabia. 31 (4) (pp 283), 2019. Date of Publication: October 2019.
Author
Alhumaidi L.; Mofarreh N.; Alghazi N.; Alenazi L.; Almutlaq S.; Alghamdi
M.
Publisher
Elsevier B.V.
Abstract
Abstract type: Clinical Research Presentation type: Oral Category:
Echocardiography (Adult) Age group: <30 Introduction: Cardiac tamponade
(CT) is medical emergency which require early and accurate
echocardiographic diagnosis. The aim of this study is to assess the
prevalence of cardiac tamponade among pericardial effusion population and
the etiology of cardiac tamponade among adult population. Due to lack of
epidemiological aspects of CT in Saudi Arabia this study were proposed.
Methodology: It is retrospective, cross-sectional study includes 93
consecutive patients of echocardiography-proven CT in the adult population
at King Abdul-Aziz Medical City between January 2010 to December 2016.
Data were collected from the electronic databases and patient medical
records. IBM SPSS and Excel were used for data management and statistical
analysis. Result(s): Pericardial effusion was diagnosed in 2,765
patients, out of whom 93 patients were identified to have CT. The
prevalence of CT was 3.36% of pericardial effusion population. 65.6% of
them were males, and 45.16% of CT patients were between 18 to less than 50
years old. The etiology of the effusion was identified in 98.92% of cases,
with malignancy, post cardiac surgery and uremia being the commonest 3
causes, at frequency of 25.81%, 17.2% and 13.98% respectively. Effusion
size >2 cm, RV diastolic collapse, non-collapsing IVC and mitral inflow
respiratory variations of >25% were presented in 64.5%, 76.3%, 71.0% and
83.9% of patients respectively. Pericardiocentesis was performed in 60.2%
of cases, 41.9% of them underwent removal of >500 cc of fluid. Shortness
of breath, HR 100, and SBP 100 mmHg were presented in 69.9%, 49.5%, and
74.2% of patients respectively. Conclusion(s): CT is uncommon and
mostly related to malignancy and post cardiac surgery. Echocardiography
has a critical diagnostic value for CT that precedes clinical hemodynamic
compromise. Copyright © 2019

<74>
Accession Number
629540016
Title
Repair of Less Than Severe Tricuspid Regurgitation during Left Sided Valve
Surgery: A Meta-Analysis.
Source
The Annals of thoracic surgery. (no pagination), 2019. Date of
Publication: 04 Oct 2019.
Author
Cao J.Y.; Wales K.M.; Zhao D.F.; Seco M.; Celermajer D.S.; Bannon P.G.
Institution
(Cao, Wales, Celermajer) Sydney Medical School, The University of Sydney,
Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital,
Sydney, Australia
(Zhao) Baird Institute of Applied Heart and Lung Surgical Research,
Sydney, Australia
(Seco, Bannon) Sydney Medical School, The University of Sydney, Sydney,
Australia; The Baird Institute of Applied Heart and Lung Surgical
Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince
Alfred Hospital, Sydney, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: To undertake a systematic review and meta-analysis
investigating the short and long-term clinical outcomes of concurrent
repair of mild or moderate tricuspid regurgitation during left sided valve
surgery. METHOD(S): Medline, PubMed, EMBASE and Cochrane Libraries
were searched and 12 studies were identified, comprising 1,373 repair and
1,553 non-repair patients. Of these, six studies were classified as low
risk of bias (randomized controlled trials or propensity matched studies)
and six at high risk of bias (non-matched observational studies). The
primary analysis included only low risk of bias studies (399 repair and
426 non-repair). RESULT(S): Primary analysis of studies at low risk
of bias demonstrated that the addition of tricuspid repair compared to
non-repair was associated with reduced risks of cardiovascular mortality,
all-cause mortality and progression of tricuspid regurgitation over a
median of 5.3 years follow up (cardiovascular mortality: RR = 0.46, 95%
CI: 0.28-0.75, p=0.002; all-cause mortality: RR = 0.68, 95% CI: 0.49-0.96,
p=0.03; TR progression: RR = 0.26, 95% CI: 0.12-0.56, p<0.001).
Cardiopulmonary bypass time was significantly lower in the non-repair
group (MWD = 18 min, 95% CI: 6-30, p=0.003), although the risk of
perioperative mortality was comparable between the two groups (RR = 0.72,
95% CI: 0.27-1.97, p>0.05) CONCLUSION(S): Concurrent repair of mild
or moderate tricuspid regurgitation during left sided valve surgery is
associated with improved long-term clinical outcomes, without adversely
impacting on early survival. Should these results be validated by ongoing
trials, there should be revision of current guidelines to recommend more
aggressive approach towards repair. Copyright © 2019. Published
by Elsevier Inc.

<75>
Accession Number
629537711
Title
Nasal High Flow Versus Conventional Oxygen Therapy for Postoperative
Cardiothoracic Surgery Patients.
Source
Dimensions of critical care nursing : DCCN. 38 (6) (pp 310-316), 2019.
Date of Publication: 01 Nov 2019.
Author
Fasolino T.; Whitten J.; Moylan M.
Institution
(Fasolino) Tracy Fasolino, PhD, RN, is an associate professor/nurse
researcher at Clemson University/Bon Secours St. Francis. She is dedicated
to improving symptom management for hospitalized patients by working with
intradisciplinary teams. Joseph Whitten, RCP, is the Director of
Respiratory Care Services at Bon Secours St. Francis Health. He is
committed to finding effective solutions for achieving quality and value
in health care. Melanie Moylan, MSc, PhD, is a research fellow and
clinical scientist of biostatistics and epidemiology at Auckland
University of Technology. She is interested in evaluating innovations and
developing clinical pathways to improve health care
Publisher
NLM (Medline)
Abstract
BACKGROUND: Reintubation and complications in postoperative cardiothoracic
patients remain high despite medical advancements. A 2-year retrospective,
observational study was conducted in postextubated cardiothoracic patients
to assess the effectiveness of the current standard-conventional oxygen
therapy (COT) compared with a nasal high flow (NHF) therapy.
 OBJECTIVE(S): The objective of this study was to understand whether
NHF therapy would reduce the need for reintubation and improve clinical
outcomes after surgery. METHOD(S): All consecutive postoperative
patients who had same-day elective cardiothoracic surgery in a tertiary
hospital were included. The 2013 data were from patients' charts who
received COT, and the 2014 data were from patients' charts after the
implementation of NHF therapy post extubation as a standard of care.
 RESULT(S): A total of 400 patient charts were analyzed: 221 and 179
patients in the COT and NHF, respectively. No significant difference was
seen in the frequency of reintubation (P = .48). Despite both cohorts
having the same length of stay (P = .10), patients treated with NHF
required less time on supplemental oxygen (P = .001). Day 1 postoperative
chest x-ray results did not show any significant differences between
groups, whereas day 2 x-rays showed worsening results in the COT cohort (P
< .001). Furthermore, the incidence of ventilator-associated pneumonia
(VAP) post extubation was significantly higher in the COT cohort, with
zero VAP episodes reported in the NHF cohort (P = .02). DISCUSSION:
Although this study was not able to demonstrate the reduction in
reintubation between groups, the use of NHF compared with COT seems to
reduce the time spent on oxygen therapy and decrease the rate of VAP.
Further evidence including randomized controlled trials is required to
determine the impact of NHF on reintubation and complications in
postoperative cardiothoracic surgery.

<76>
[Use Link to view the full text]
Accession Number
629537597
Title
Effects of bronchial blockers on one-lung ventilation in general
anesthesia: A randomized controlled trail.
Source
Medicine. 98 (41) (pp e17387), 2019. Date of Publication: 01 Oct 2019.
Author
Zheng M.; Niu Z.; Chen P.; Feng D.; Wang L.; Nie Y.; Wang B.; Zhang Z.;
Shan S.
Institution
(Zheng) Department of Anesthesiology, Cangzhou Central Hospital, Hebei
Province, Cangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Double-lumen bronchial tubes (DLBT) and bronchial blockers
(BB) are commonly used in the anesthesia for clinical thoracic surgery.
But there are few systematic clinical comparisons between them. In this
study, the effects of BB and DLBT on one-lung ventilation (OLV) are
studied. METHOD(S): The 200 patients with thoracic tuberculosis
undergoing thoracic surgery, were randomly assigned to group A (DLBT) and
group B (BB). Intubation time, hemodynamic changes (mean arterial pressure
[MAP], heart rate [HR]), and arterial blood gas indicators (arterial
partial pressure of carbon dioxide [PaCO2], arterial partial pressure of
oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure
[Ppeak]) at 4 time points were recorded. Complications such as hoarseness,
pulmonary infection, pharyngalgia, and surgical success rate were also
evaluated postoperatively. RESULT(S): Intubation times were shorter
in group B. Both MAP and HR in group A were significantly higher 1 minute
after intubation than before, but also higher than those in group B. PaO2
levels were lower in both groups during (OLV) than immediately after
anesthesia and after two-lung ventilation (TLV), with PaO2 being lower
after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both
points during OLV, PaO2 was lower in group A than in group B. No
significant differences in PaCO2 were found between the 2 groups. Ppeak
and Pplat were increased in both groups during OLV, with both being higher
in group A than in group B. The incidence of postoperative hoarseness,
pulmonary infection, and pharyngalgia were lower in group B. There was no
significant difference in the success rate of operation between the 2
groups. CONCLUSION(S): Compare with using DLBT, implementation of BB
in general anesthesia has less impact on hemodynamics, PaO2 and airway
pressures, and achieves lower incidence of postoperative complication.

<77>
Accession Number
629536511
Title
Reducing blood loss in pediatric craniosynostosis surgery by use of
tranexamic acid.
Source
Neuro-Chirurgie. (no pagination), 2019. Date of Publication: 03 Oct 2019.
Author
Eustache G.; Riffaud L.
Institution
(Eustache) Univ Rennes, CHU Rennes, Department of Anaesthesiology, Rennes
F-35000, France
(Riffaud) Univ Rennes, CHU Rennes, Department of Neurosurgery, F-35000,
Rennes, France; INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University,
Rennes, France
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Craniosysnostosis surgical corrections are routine
procedures in the pediatric neurosurgical field. However, these procedures
result in significant blood loss. Tranexamic acid (TXA) is an
antifibrinolytic drug which has demonstrated a significant reduction in
perioperative blood loss in many pediatric surgical procedures such as
cardiac surgery and scoliosis surgery. We conducted a systematic review to
evaluate protocols of TXA use in pediatric craniosynostosis procedures and
its effect on intra-operative blood loss and transfusions. MATERIAL AND
METHODS: A comprehensive literature review of the National Library of
Medicine (PubMed) database was performed to identify relevant studies. We
included any clinical study reporting on blood loss or blood transfusion
for pediatric craniosynostosis surgery with intraoperative use of
tranexamic acid, with the following limits: publication date from
inception to May 2019; reports in English. RESULT(S): Thirteen
studies were eligible for our review. Of the 13 studies, 4 were
prospective, randomized, double-blind controlled trials, 9 were
retrospective studies, tailored as a "before-after" studies, comparing
blood loss and transfusion without/with TXA. TXA significantly decreases
the number and volume of packed red blood cell transfusions and the rate
of transfusion in children undergoing craniosynostosis surgery.
Significantly fewer fresh frozen plasma transfusions were required in the
TXA groups in 2 randomized studies. Length of stay in hospital was
significantly lower with the use of TXA in three studies. Advantages of
TXA administration also include an excellent patient tolerance of side
effects, ease of administration and low cost. CONCLUSION(S): TXA
significantly reduces blood loss and the need for transfusions in children
undergoing craniosynostosis surgery. TXA administration should be a
routine part of strategy to reduce blood loss and limit transfusions in
these procedures. Copyright © 2019 Elsevier Masson SAS. All
rights reserved.

<78>
[Use Link to view the full text]
Accession Number
629493849
Title
Standard median sternotomy, right minithoracotomy, totally thoracoscopic
surgery, percutaneous closure, and transthoracic closure for atrial septal
defects in children: A protocol for a network meta-analysis.
Source
Medicine (United States). 98 (38) (no pagination), 2019. Article Number:
e17270. Date of Publication: 01 Sep 2019.
Author
Yi K.; Guo X.; You T.; Wang Y.; Ding F.; Hou X.; Zhou L.
Institution
(Yi, You, Ding, Hou) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, No. 204, Dong gang West Road, Chengguan District,
Lanzhou City, Gansu Province, China
(Yi, You, Ding, Hou) International Congenital Heart Disease Diagnosis and
Treatment Reginal Center, Lanzhou, China
(Guo) First Clinical Medical College, Lanzhou University, Lanzhou, China
(Wang) Department of Endocrinology, Gansu Provincial Hospital, Lanzhou,
China
(Zhou) Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background:Atrial septal defect (ASD) is one of the most common congenital
heart diseases, with an average of 1.64 per 1000 newborns with the ASD.
Empirical studies suggest that surgery should be performed early in the
presence of right atrium and or right ventricular enlargement, even for
asymptomatic patients. Many surgical procedures can be used to treat ASD.
But which method is the best choice remains unclear. This study aims to
compare the efficacy and safety of standard median sternotomy, right
minithoracotomy, totally thoracoscopic surgery, percutaneous closure,
transcutaneous by echocardiography, and transcutaneous by radiotherapy for
ASDs in children using Bayesian network meta-analysis (NMA).
 Method(s):We will perform a comprehensive literature search using
PubMed, EMBASE.com, the Cochrane Library, Web of Science, and Chinese
Biomedical Literature Database to identify relevant studies from inception
to April 2019. Randomized controlled trials, prospective or retrospective
cohort studies that reported the efficacy and safety of surgical
procedures for the treatment of atrial septal defects will be included.
Risk of bias of the included randomized controlled trials and prospective
or retrospective cohort studies will be evaluated according to the
Cochrane Handbook 5.1.0 and the risk of bias in non-randomized studies of
interventions, respectively. A Bayesian NMA will be performed using R
3.4.1. Result(s):The results of this NMA will be submitted to a
peer-reviewed journal for publication. Conclusion(s):This NMA will
summarize the direct and indirect evidence to assess the efficacy and
safety of different surgical procedures for the treatment of ASDs.Ethics
and dissemination:Ethics approval and patient consent are not required as
this study is a network meta-analysis based on published trials.PROSPERO
registration number:CRD42019130902. Copyright © 2019 the
Author(s). Published by Wolters Kluwer Health, Inc.

<79>
Accession Number
2001920368
Title
A Pilot Randomized Controlled Study of Mild Hypercapnia During Cardiac
Surgery With Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33 (11) (pp 2968-2978),
2019. Date of Publication: November 2019.
Author
Chan M.J.; Lucchetta L.; Cutuli S.; Eyeington C.; Glassford N.J.;
Martensson J.; Angelopoulos P.; Matalanis G.; Weinberg L.; Eastwood G.M.;
Bellomo R.
Institution
(Chan, Lucchetta, Cutuli, Eyeington, Glassford, Martensson, Eastwood,
Bellomo) Department of Intensive Care, Austin Hospital, Melbourne,
Australia
(Angelopoulos) Department of Cardiac Perfusion, Austin Hospital,
Melbourne, Australia
(Matalanis) Department of Cardiac Surgery, Austin Hospital, Melbourne,
Australia
(Weinberg) Department of Anaesthesia, Austin Hospital, Melbournez,
Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
(Bellomo) Data Assessment Research Evaluation Centre, University of
Melbourne and Austin Hospital, Melbourne, Australia
Publisher
W.B. Saunders
Abstract
Objectives: To test whether targeted therapeutic mild hypercapnia (TTMH)
would attenuate cerebral oxygen desaturation detected using near-infrared
spectroscopy during cardiac surgery requiring cardiopulmonary bypass
(CPB). Design(s): Randomized controlled trials. Setting(s):
Operating rooms and intensive care unit of tertiary hospital.
 Participant(s): The study comprised 30 patients undergoing cardiac
surgery with CPB. Intervention(s): Patients were randomly assigned to
receive either standard carbon dioxide management (normocapnia) or TTMH
(target arterial carbon dioxide partial pressure between 50 and 55 mmHg)
throughout the intraoperative period and postoperatively until the onset
of spontaneous ventilation. Measurements and Main Results: Relevant
biochemical and hemodynamic variables were measured, and cerebral tissue
oxygen saturation (SctO<inf>2</inf>) was monitored with near-infrared
spectroscopy. Patients were followed-up with neuropsychological testing.
Patient demographics between groups were compared using the Fisher exact
and Mann-Whitney tests, and SctO<inf>2</inf> between groups was compared
using repeated measures analysis of variance. The median patient age was
67 years (interquartile range [IQR] 62-72 y), and the median EuroSCORE II
was 1.1. The median CPB time was 106 minutes. The mean intraoperative
arterial carbon dioxide partial pressure for each patient was
significantly higher with TTMH (52.1 mmHg [IQR 49.9-53.9 mmHg] v 40.8 mmHg
[IQR 38.7-41.7 mmHg]; p < 0.001) as was pulmonary artery pressure (23.9
mmHg [IQR 22.4-25.3 mmHg] v 18.5 mmHg [IQR 14.8-20.7 mmHg]; p = 0.004).
There was no difference in mean percentage change in SctO<inf>2</inf>
during CPB in the control group for both hemispheres (left: -6.7% v -2.3%;
p = 0.110; right: -7.9% v -1.0%; p = 0.120). Compliance with
neuropsychological test protocols was poor. However, the proportion of
patients with drops in test score >20% was similar between groups in all
tests. Conclusion(s): TTMH did not increase SctO<inf>2</inf>
appreciably during CPB but increased pulmonary artery pressures before and
after CPB. These findings do not support further investigation of TTMH as
a means of improving SctO<inf>2</inf> during and after cardiac surgery
requiring CPB. Copyright © 2019 Elsevier Inc.

<80>
Accession Number
628508211
Title
Inspiratory Muscle Training after Heart Valve Replacement Surgery Improves
Inspiratory Muscle Strength, Lung Function, and Functional Capacity: A
RANDOMIZED CONTROLLED TRIAL.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 39 (5) (pp
E1-E7), 2019. Date of Publication: 01 Sep 2019.
Author
Cargnin C.; Karsten M.; Guaragna J.C.V.D.C.; Dal Lago P.
Institution
(Cargnin, Dal Lago) Programa de Pos-graduacao em Ciencias da Saude,
Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto
Alegre, Brazil
(Karsten, Dal Lago) Programa de Pos-graduacao em Ciencias da Reabilitacao,
Porto Alegre, Brazil
(Karsten) Departamento de Fisioterapia, Universidade Do Estado de Santa
Catarina (UDESC), Florianopolis, Brazil
(Karsten) Programa de Pos-graduacao em Fisioterapia (UDESC),
Florianopolis, Brazil
(Guaragna) Faculdade de Medicina, Pontificia Universidade Catolica Do Rio
Grande Do sul (PUCRS), Porto Alegre, Brazil
(Dal Lago) Departamento de Fisioterapia, Universidade Federal de Ciencias
da Saude de Porto Alegre-UFSCPA, Rua Sarmento Leite, 245, Porto Alegre,
Rio Grande do Sul 90050-170, Brazil
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: The aim of this study was to analyze the effects of inspiratory
muscle training (IMT) as a therapeutic strategy after heart valve
replacement surgery (HVRS). Method(s): A double-blind, randomized,
clinical trial that included patients undergoing elective HVRS, without
post-operative complications, were allocated to 2 groups: IMT group
(IMT-G) and IMT placebo group (IMT-PG). The IMT started 3 d after surgery
and was performed twice daily for 4 wk. Lung function, maximum inspiratory
pressure (MIP) as a measure of inspiratory muscle strength, functional
capacity, and quality of life were assessed pre-operatively and at the end
of training. Result(s): The IMT-G recovered pre-operative MIP and
lung function values after 4 wk of training. This group also increased the
distance walked during the 6-min walk test (6MWD). In the IMT-PG, the
values of MIP were below those found pre-operatively, with impairment of
lung function and lower 6MWD in the final evaluation. At the end of IMT,
MIP was correlated with the 6MWD and with the spirometry variables.
 Conclusion(s): IMT performed for 4 wk after HVRS was effective in
restoring the values of inspiratory muscle strength and lung function to
the pre-operative level and increasing the functional capacity assessed by
the 6MWD. Furthermore, an association between lung function and functional
capacity was observed, demonstrating the clinical relevance of the use of
IMT in the rehabilitation process of these patients. Copyright ©
2019 Wolters Kluwer Health, Inc. All rights reserved.

<81>
Accession Number
624459600
Title
Oral anticoagulant use in cardiovascular disorders: a perspective on
present and potential indications for rivaroxaban.
Source
Current Medical Research and Opinion. 34 (11) (pp 1945-1957), 2018. Date
of Publication: 02 Nov 2018.
Author
Camm A.J.; Fox K.A.A.
Institution
(Camm) Cardiovascular and Cell Sciences Research Institute, St George's,
University of London and Imperial College, London, United Kingdom
(Fox) Centre for Cardiovascular Science, University of Edinburgh and Royal
Infirmary of Edinburgh, Edinburgh, United Kingdom
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Background: Four non-vitamin-K-antagonist oral anticoagulants (NOACs) have
been approved for use in various cardiovascular indications. The direct
thrombin inhibitor dabigatran and the direct factor Xa inhibitors
apixaban, edoxaban and rivaroxaban are now increasingly used in clinical
practice. For some of these agents, available data from real-world studies
support the efficacy and safety data in phase III clinical trials.
 Objective(s): This review aims to summarize the current status of
trials and observational studies of oral anticoagulant use over the
spectrum of cardiovascular disorders (excluding venous thrombosis),
provide a reference source beyond stroke prevention for atrial
fibrillation (AF) and examine the potential for novel applications in the
cardiovascular field. Method(s): We searched the recent literature
for data on completed and upcoming trials of oral anticoagulants with a
particular focus on rivaroxaban. Result(s): Recent data in specific
patient subgroups, such as patients with AF undergoing catheter ablation
or cardioversion, have led to an extended approval for rivaroxaban,
whereas the other NOACs have ongoing or recently completed trials in this
setting. However, there are unmet medical needs for several arterial
thromboembolic-related conditions, including patients with: AF and acute
coronary syndrome, AF and coronary artery disease undergoing elective
percutaneous coronary intervention, coronary artery disease and peripheral
artery disease, implanted cardiac devices, and embolic stroke of unknown
source. Conclusion(s): NOACs may provide alternative treatment
options in areas of unmet need, and numerous studies are underway to
assess their benefit-risk profiles in these settings. Copyright ©
2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

<82>
Accession Number
624050339
Title
Association of perioperative red blood cell transfusions with venous
thromboembolism in a North American Registry.
Source
JAMA Surgery. 153 (9) (pp 826-833), 2018. Date of Publication: September
2018.
Author
Goel R.; Patel E.U.; Cushing M.M.; Frank S.M.; Ness P.M.; Takemoto C.M.;
Vasovic L.V.; Sheth S.; Nellis M.E.; Shaz B.; Tobian A.A.R.
Institution
(Goel, Cushing, Vasovic) Division of Transfusion Medicine, Department of
Pathology, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Goel, Sheth) Division of Pediatric Hematology/Oncology, Department of
Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Patel, Ness, Tobian) Division of Transfusion Medicine, Department of
Pathology, Johns Hopkins University, Baltimore, MD, United States
(Frank) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins Medical Institutions, Baltimore, MD, United States
(Takemoto) Division of Pediatric Hematology, Johns Hopkins University,
Baltimore, MD, United States
(Nellis) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New
York, United States
(Shaz) New York Blood Center, New York, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Increasing evidence supports the role of red blood cells (RBCs)
in physiological hemostasis and pathologic thrombosis. Red blood cells are
commonly transfused in the perioperative period; however, their
association with postoperative thrombotic events remains unclear.
OBJECTIVE To examine the association between perioperative RBC
transfusions and postoperative venous thromboembolism (VTE) within 30 days
of surgery. DESIGN, SETTING, AND PARTICIPANTS This analysis used
prospectively collected registry data from the American College of Surgery
National Surgical Quality Improvement Program (ACS-NSQIP) database, a
validated registry of 525 teaching and nonteaching hospitals in North
America. Participants included patients in the ACS-NSQIP registry who
underwent a surgical procedure from January 1 through December 31, 2014.
Data were analyzed from July 1, 2016, through March 15, 2018. MAIN
OUTCOMES AND MEASURES Risk-adjusted odds ratios (aORs) were estimated
using multivariable logistic regression. The primary outcome was the
development of postoperative VTE (deep venous thrombosis [DVT] and
pulmonary embolism [PE]) within 30 days of surgery that warranted
therapeutic intervention; DVT and PE were also examined separately as
secondary outcomes. Subgroup analyses were performed by surgical subtypes.
Propensity score matching was performed for sensitivity analyses. RESULTS
Of 750 937 patients (56.8% women; median age, 58 years; interquartile
range, 44-69 years), 47 410 (6.3%) received at least 1 perioperative RBC
transfusion. Postoperative VTE occurred in 6309 patients (0.8%) (DVT in
4336 [0.6%]; PE in 2514 [0.3%]; both DVT and PE in 541 [0.1%]).
Perioperative RBC transfusion was associated with higher odds of VTE (aOR,
2.1; 95% CI, 2.0-2.3), DVT (aOR, 2.2; 95% CI, 2.1-2.4), and PE (aOR, 1.9;
95% CI, 1.7-2.1), independent of various putative risk factors. A
significant dose-response effect was observed with increased odds of VTE
as the number of intraoperative and/or postoperative RBC transfusion
events increased (aOR, 2.1 [95% CI, 2.0-2.3] for 1 event; 3.1 [95% CI,
1.7-5.7] for 2 events; and 4.5 [95% CI, 1.0-19.4] for 3 events vs no
intraoperative or postoperative RBC transfusion; P < .001 for trend). In
subgroup analyses, the association between any perioperative RBC
transfusion and postoperative VTE remained statistically significant
across all surgical subspecialties analyzed. The association between any
perioperative RBC transfusion and the development of postoperative VTE
also remained robust after 1:1 propensity score matching (47 142 matched
pairs; matched OR, 1.9; 95% CI, 1.8-2.1). CONCLUSIONS AND RELEVANCE The
results of this study suggest that perioperative RBC transfusions may be
significantly associated with the development of new or progressive
postoperative VTE, independent of several putative confounders. These
findings, if validated, should reinforce the importance of rigorous
perioperative management of blood transfusion practices. Copyright
© 2018 American Medical Association. All rights reserved.

<83>
[Use Link to view the full text]
Accession Number
624836480
Title
Protective ventilation during anaesthesia reduces major postoperative
complications after lung cancer surgery: A double-blind randomised
controlled trial.
Source
European Journal of Anaesthesiology. 35 (10) (pp 727-735), 2018. Date of
Publication: 2018.
Author
Marret E.; Cinotti R.; Berard L.; Piriou V.; Jobard J.; Barrucand B.; Radu
D.; Jaber S.; Bonnet F.
Institution
(Marret, Bonnet) Department of Anaesthesia and Intensive Care Medicine,
American Hospital of Paris, 63 Bd Victor Hugo, Neuilly-sur-Seine, Paris,
France
(Cinotti) Department of Anaesthesia and Intensive Care Medicine, Hotel
Dieu, CHU de Nantes, Nantes Cedex, France
(Berard) Clinical Research Platform (URC-CRC-CRB), AP-HP Hopital
Saint-Antoine, Paris, France
(Berard) INSERM, U-698, UPMC-Paris 06, Paris, France
(Piriou) Critical Care and Anaesthesia Department, CHU Lyon Sud,
University Lyon 1, Lyon, France
(Jobard) Department of Anesthesia and Intensive Care Medicine, Princess
Grace Hospital, Monaco, France
(Barrucand) Department of Anaesthesia and Intensive Care Medicine,
University Hospital of Besancon, Besancon, France
(Radu) Department of Anaesthesia and Intensive Care Medicine, Hotel Dieu,
Cochin University Hospitals, AP-HP, Universite Paris Descartes, Paris,
France
(Jaber) Research Unit, INSERM U1046, Saint Eloi University Hospital,
Montpellier School of Medicine, Montpellier, France
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Thoracic surgery for lung resection is associated with a high
incidence of postoperative pulmonary complications. Controlled ventilation
with a large tidal volume has been documented to be a risk factor for
postoperative respiratory complications after major abdominal surgery,
whereas the use of low tidal volumes and positive end-expiratory pressure
(PEEP) has a protective effect. OBJECTIVE To evaluate the effects of
ventilation with low tidal volume and PEEP on major complications after
thoracic surgery. DESIGN A double-blind, randomised controlled study.
SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A
total of 346 patients undergoing lobectomy or pneumonectomy for lung
cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of
major postoperative complications (pneumonia, acute lung injury, acute
respiratory distress syndrome, pulmonary embolism, shock, myocardial
infarction or death) within 30 days after surgery. INTERVENTIONS Patients
were randomly assigned to receive either lung-protective ventilation (LPV
group) [tidal volume 5 ml kg1 ideal body weight R PEEP between
5 and 8 cmH<inf>2</inf>O] or nonprotective ventilation (control group)
(tidal volume 10 ml kg1 ideal body weight without PEEP) during
anaesthesia. RESULTS The trial was stopped prematurely because of an
insufficient inclusion rate. Major postoperative complications occurred in
23/172 patients in the LPV group (13.4%) vs. 38/ 171 (22.2%) in the
control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P
1/4 0.03). The incidence of other complications (supraventricular cardiac
arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia,
bronchial fistula and persistent air leak) was also lower in the LPV group
(37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P
1/4 0.02).The duration of hospital stay was shorter in the LPV group, 11
[interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P 1/4 0.048.
CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low
tidal volume and PEEP during anaesthesia for lung cancer surgery seems to
improve postoperative outcomes. Copyright © 2018 European Society
of Anaesthesiology. All rights reserved.

<84>
Accession Number
629527692
Title
Protocol for the electroencephalography guidance of anesthesia to
alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic,
randomized clinical trial.
Source
F1000Research. 8 (pp 1165), 2019. Date of Publication: 2019.
Author
Deschamps A.; Saha T.; El-Gabalawy R.; Jacobsohn E.; Overbeek C.; Palermo
J.; Robichaud S.; Dumont A.A.; Djaiani G.; Carroll J.; Kavosh M.S.;
Tanzola R.; Schmitt E.M.; Inouye S.K.; Oberhaus J.; Mickle A.; Ben
Abdallah A.; Avidan M.S.; Clinical Trials Group C.P.A.
Institution
(Deschamps) Department of Anesthesiology and Pain Medicine, Montreal Heart
Institute and Universite de Montreal, Montreal, QC H1T 1C8, Canada
(Saha, Tanzola) Department of Anesthesiology and Perioperative Medicine,
Queen's University, Kingston, Kingston, Ontario, Canada
(El-Gabalawy) Department of Clinical Health Psychology, Anesthesiology,
Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB,
Canada
(Jacobsohn) Departments of Anesthesia and Internal Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Overbeek, Palermo) Department of Anesthesiology and Pain Medicine,
University of Montreal, Montreal, QC, Canada
(Robichaud) Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
(Dumont) Montreal Health Innovation Coordinating Center, Montreal Heart
Institute, Montreal, QC, Canada
(Djaiani, Carroll) Department of Anesthesia, University of Toronto,
Toronto, ON, Canada
(Kavosh) Department of Anesthesiology, Perioperative and Pain Medicine,
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Schmitt, Inouye) Department of Medicine, Beth Israel Deaconess Medical
Center, Boston, United States
(Oberhaus, Mickle, Ben Abdallah, Avidan) Department of Anesthesiology,
Washington University School of Medicine, MO, United States
(Clinical Trials Group) Department of Anesthesia, University of Manitoba,
Winnipeg, MB, Canada
Publisher
NLM (Medline)
Abstract
Background: There is some evidence that electroencephalography guidance of
general anesthesia can decrease postoperative delirium after non-cardiac
surgery. There is limited evidence in this regard for cardiac surgery. A
suppressed electroencephalogram pattern, occurring with deep anesthesia,
is associated with increased incidence of postoperative delirium (POD) and
death. However, it is not yet clear whether this electroencephalographic
pattern reflects an underlying vulnerability associated with increased
incidence of delirium and mortality, or whether it is a modifiable risk
factor for these adverse outcomes. Method(s): The Electroe
ncephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (
ENGAGES-Canada) is an ongoing pragmatic 1200 patient trial at four
Canadian sites. The study compares the effect of two anesthetic management
approaches on the incidence of POD after cardiac surgery. One approach is
based on current standard anesthetic practice and the other on
electroencephalography guidance to reduce POD. In the guided arm,
clinicians are encouraged to decrease anesthetic administration, primarily
if there is electroencephalogram suppression and secondarily if the EEG
index is lower than the manufacturers recommended value (bispectral index
(BIS) or WAVcns below 40 or Patient State Index below 25). The aim in the
guided group is to administer the minimum concentration of anesthetic
considered safe for individual patients. The primary outcome of the study
is the incidence of POD, detected using the confusion assessment method or
the confusion assessment method for the intensive care unit; coupled with
structured delirium chart review. Secondary outcomes include unexpected
intraoperative movement, awareness, length of intensive care unit and
hospital stay, delirium severity and duration, quality of life, falls, and
predictors and outcomes of perioperative distress and dissociation.
 Discussion(s): The ENGAGES-Canada trial will help to clarify whether
or not using the electroencephalogram to guide anesthetic administration
during cardiac surgery decreases the incidence, severity, and duration of
POD. Registration: ClinicalTrials.gov ( NCT02692300)
26/02/2016. Copyright: © 2019 Deschamps A et al.

<85>
Accession Number
629526609
Title
High-Sensitivity Cardiac Troponin and the Universal Definition of
Myocardial Infarction.
Source
Circulation. (no pagination), 2019. Date of Publication: 07 Oct 2019.
Author
Chapman A.R.; Adamson P.D.; Shah A.S.V.; Anand A.; Strachan F.E.; Ferry
A.V.; Lee K.K.; Berry C.; Findlay I.; Cruickshank A.; Reid A.; Gray A.;
Collinson P.O.; Apple F.; McAllister D.A.; Maguire D.; Fox K.A.A.;
Vallejos C.A.; Keerie C.; Weir C.J.; Newby D.E.; Mills N.L.
Institution
(Chapman, Shah, Anand, Strachan, Ferry, Lee, Fox, Newby) BHF Centre for
Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
(Adamson) BHF Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, UK; Christchurch Heart Institute, University of Otago,
Christchurch, NZ
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, United Kingdom
(Findlay) Department of Cardiology, Royal Alexandra Hospital, Paisley,
United Kingdom
(Cruickshank) Department of Biochemistry, Queen Elizabeth University
Hospital, Glasgow, United Kingdom
(Reid) Department of Biochemistry, Queen Elizabeth University Hospital,
Glasgow, United Kingdom
(Gray) Emergency Medicine Research Group Edinburgh, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Collinson) Departments of Clinical Blood Sciences and Cardiology,
University Hospitals NHS Trust and St George's University of London, St
George's, London, United Kingdom
(Apple) Department of Laboratory Medicine and Pathology, Hennepin
Healthcare/Hennepin County Medical Center & University of Minnesota, MN,
Minneapolis, United States
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
(Maguire) Emergency Medicine Department, Glasgow Royal Infirmary, Glasgow,
United Kingdom
(Vallejos) MRC Human Genetics Unit, University of Edinburgh, Edinburgh UK;
The Alan Turing Institute, London, UK
(Keerie, Weir) Edinburgh Clinical Trials Unit, University of Edinburgh,
Edinburgh, UK; Usher Institute of Population Health Sciences and
Informatics, University of Edinburgh, Edinburgh, UK
(Mills) BHF Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, UK; Usher Institute of Population Health Sciences and
Informatics, University of Edinburgh, Edinburgh, UK
Publisher
NLM (Medline)
Abstract
Background: The introduction of more sensitive cardiac troponin assays has
led to increased recognition of myocardial injury in acute illnesses other
than acute coronary syndrome. The Universal Definition of Myocardial
Infarction recommends high-sensitivity cardiac troponin (hs-cTn) testing
and classification of patients with myocardial injury based on aetiology,
but the clinical implications of implementing this guideline are not well
understood. Method(s): In a stepped-wedge cluster randomized
controlled trial, we implemented a hs-cTn assay and the recommendations of
the Universal Definition in 48,282 consecutive patients with suspected
acute coronary syndrome. In a pre-specified secondary analysis, we
compared the primary outcome of myocardial infarction or cardiovascular
death and secondary outcome of non-cardiovascular death at one year across
diagnostic categories. Result(s): Implementation increased the
diagnosis of type 1 myocardial infarction by 11% (510/4,471), type 2
myocardial infarction by 22% (205/916), and acute and chronic myocardial
injury by 36% (443/1,233) and 43% (389/898), respectively. Compared to
those without myocardial injury, the rate of the primary outcome was
highest in those with type 1 myocardial infarction (cause-specific hazard
ratio [csHR] 5.64, 95% confidence interval [CI] 5.12 to 6.22), but was
similar across diagnostic categories, whereas non-cardiovascular deaths
were highest in those with acute myocardial injury (csHR 2.65, 95%CI 2.33
to 3.01). Despite modest increases in anti-platelet therapy and coronary
revascularization after implementation in patients with type 1 myocardial
infarction, the primary outcome was unchanged (csHR 1.00, 95%CI 0.82 to
1.21). Increased recognition of type 2 myocardial infarction and
myocardial injury did not lead to changes in investigation, treatment or
outcomes. Conclusion(s): Implementation of high-sensitivity cardiac
troponin and the recommendations of the Universal Definition of Myocardial
Infarction identified patients at high-risk of cardiovascular and
non-cardiovascular events, but was not associated with consistent
increases in treatment or improved outcomes. Trials of secondary
prevention are urgently required to determine whether this risk is
modifiable in patients without type 1 myocardial infarction. Clinical
Trial Registration: URL: https://clinicaltrials.gov Unique Identifier:
NCT0185212.

<86>
Accession Number
629523922
Title
The Prediction Model of Warfarin Individual Maintenance Dose for Patients
Undergoing Heart Valve Replacement, Based on the Back Propagation Neural
Network.
Source
Clinical drug investigation. (no pagination), 2019. Date of Publication:
04 Oct 2019.
Author
Li Q.; Wang J.; Tao H.; Zhou Q.; Fu B.; Qin W.; Li D.; Hou J.; Chen J.;
Zhang W.-H.
Institution
(Li, Chen) Department of Evidence-Based Medicine and Clinical
Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan
610041, China
(Wang) Department of Career Development Division, Fourth Affiliated
Hospital of Anhui Medical University, Hefei, China
(Tao) Department of Hematology, West China Hospital, Sichuan University,
Chengdu, China
(Zhou) Department of Nutrition, Second Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Chen) Department of Anesthesiology, China Mianyang Central Hospital,
Mianyang, China
(Fu) Department of Cardiovascular Surgery, Tianjin Central Hospital,
Tianjin, China
(Qin) Department of Social Medicine and Health Management, Shandong
University, Jinan, China
(Li, Hou) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Chengdu, China
(Zhang) Department of Research Laboratory for Human Reproduction, Faculty
of Medicine and School of Public Health, Universite Libre de Bruxelles
(ULB), Brussels, Belgium
(Zhang) International Centre for Reproductive Health (ICRH), Department of
Public Health and Primary Care, Ghent University, Ghent, Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND AND OBJECTIVE: Because of the narrow therapeutic window and
huge inter-individual variation, the individual precision on anticoagulant
therapy of warfarin is challenging. In our study, we aimed to construct a
Back Propagation Neural Network (BPNN) model to predict the individual
warfarin maintenance dose among Chinese patients who have undergone heart
valve replacement, and validate its prediction accuracy. METHOD(S):
In this study, we analyzed 13,639 eligible patients extracted from the
Chinese Low Intensity Anticoagulant Therapy after Heart Valve Replacement
database, which collected data on patients using warfarin after heart
valve replacement from 15 centers all over China. Ten percent of patients
who were finally enrolled in the database were used as the external
validation, while the remaining were randomly divided into the training
and internal validation groups at a ratio of 3:1. Input variables were
selected by univariate analysis of the general linear model; 2.0, the mean
value of the international normalized ratio (INR) range 1.5-2.5, was used
as the mandatory variable. The BPNN model and the multiple linear
regression (MLR) model were constructed by the training group and
validated through comparisons of the mean absolute error (MAE), mean
squared error (MSE), root mean squared error (RMSE), and ideal predicted
percentage. RESULT(S): Finally, 10 input variables were selected and
a three-layer BPNN model was constructed. In the BPNN model, the value of
MAE (0.688 mg/day and 0.740 mg/day in internal and external validation,
respectively), MSE (0.580 mg/day and 0.599 mg/day in internal and external
validation, respectively), and RMSE (0.761 mg/day and 0.774 mg/day in
internal and external validation, respectively) were achieved. Ideal
predicted percentages were high in both internal (63.0%) and external
validation (59.7%), respectively. Compared with the MLR model, the BPNN
model showed a higher ideal prediction percentage in the external
validation group (59.7% vs. 56.6%), and showed the best prediction
accuracy in the intermediate-dose subgroup (internal validation group:
85.2%; external validation group: 84.7%) and a high predicted percentage
in the high-dose subgroup (internal validation group: 36.2%; external
validation group: 39.8%), but poor performance in the low-dose subgroup
(internal validation group: 0%; external validation group: 0.3%).
Meanwhile, the BPNN model showed better ideal prediction percentage in the
high-dose group than the MLR model (internal validation: 36.2% vs. 31.6%;
external validation: 42.8% vs. 37.8%). CONCLUSION(S): The BPNN model
shows promise for predicting the warfarin maintenance dose after heart
valve replacement.

<87>
Accession Number
629522228
Title
Clinical Prediction Models for Valvular Heart Disease.
Source
Journal of the American Heart Association. 8 (20) (pp e011972), 2019. Date
of Publication: 15 Oct 2019.
Author
Wessler B.S.; Lundquist C.M.; Koethe B.; Park J.G.; Brown K.; Williamson
T.; Ajlan M.; Natto Z.; Lutz J.S.; Paulus J.K.; Kent D.M.
Institution
(Wessler, Lundquist, Koethe, Park, Brown, Williamson, Ajlan, Lutz, Paulus,
Kent) Predictive Analytics and Comparative Effectiveness (PACE) Center
Institute for Clinical Research and Health Policy Studies (ICRHPS) Tufts
Medical Center Boston MA
(Wessler) Division of Cardiology Tufts Medical Center Boston MA
(Natto) Department of Dental Public Health Faculty of Dentistry King
Abdulaziz University Jeddah Saudi Arabia
Publisher
NLM (Medline)
Abstract
Background While many clinical prediction models (CPMs) exist to guide
valvular heart disease treatment decisions, the relative performance of
these CPMs is largely unknown. We systematically describe the CPMs
available for patients with valvular heart disease with specific attention
to performance in external validations. Methods and Results A systematic
review identified 49 CPMs for patients with valvular heart disease treated
with surgery (n=34), percutaneous interventions (n=12), or no intervention
(n=3). There were 204 external validations of these CPMs. Only 35 (71%)
CPMs have been externally validated. Sixty-five percent (n=133) of the
external validations were performed on distantly related populations.
There was substantial heterogeneity in model performance and a median
percentage change in discrimination of -27.1% (interquartile range,
-49.4%--5.7%). Nearly two-thirds of validations (n=129) demonstrate at
least a 10% relative decline in discrimination. Discriminatory performance
of EuroSCORE II and Society of Thoracic Surgeons (2009) models (accounting
for 73% of external validations) varied widely: EuroSCORE II validation
c-statistic range 0.50 to 0.95; Society of Thoracic Surgeons (2009) Models
validation c-statistic range 0.50 to 0.86. These models performed well
when tested on related populations (median related validation
c-statistics: EuroSCORE II, 0.82 [0.76, 0.85]; Society of Thoracic
Surgeons [2009], 0.72 [0.67, 0.79]). There remain few (n=9) external
validations of transcatheter aortic valve replacement CPMs. Conclusions
Many CPMs for patients with valvular heart disease have never been
externally validated and isolated external validations appear insufficient
to assess the trustworthiness of predictions. For surgical valve
interventions, there are existing predictive models that perform
reasonably well on related populations. For transcatheter aortic valve
replacement (CPMs additional external validations are needed to broadly
understand the trustworthiness of predictions.

<88>
[Use Link to view the full text]
Accession Number
629520079
Title
Impact of Procedural Bleeding in Peripheral Artery Disease: An Analysis
From EUCLID Trial.
Source
Circulation. Cardiovascular interventions. 12 (10) (pp e008069), 2019.
Date of Publication: 01 Oct 2019.
Author
Kansal A.; Huang Z.; Rockhold F.W.; Baumgartner I.; Berger J.S.; Blomster
J.I.; Fowkes F.G.; Katona B.; Mahaffey K.W.; Norgren L.; Hiatt W.R.; Patel
M.R.; Jones W.S.
Institution
(Kansal, Patel, Jones) Division of Cardiology, Duke Heart Center (A.K.,
M.R.P., Duke University, Durham
(Huang, Rockhold, Patel, Jones) Duke Clinical Research Institute, Duke
University School of Medicine (Z.H., M.R.P., Duke University, Durham
(Baumgartner) Swiss Cardiovascular Centre, Inselspital, Bern University
Hospital, University of Bern
(Berger) Departments of Medicine and Surgery, New York University School
of Medicine (J.S.B.)
(Blomster) Turku University Hospital, Turku University, Finland (J.I.B.)
(Fowkes) Usher Institute of Population Health Sciences and Informatics,
University of Edinburgh, United Kingdom (F.G.F.)
(Katona) AstraZeneca Gaithersburg, MD (B.K.)
(Mahaffey) Stanford Center for Clinical Research, Stanford University
School of Medicine
(Norgren) Faculty of Medicine and Health, Orebro University
(Hiatt) University of Colorado School of Medicine, Division of Cardiology
and CPC Clinical Research
Publisher
NLM (Medline)
Abstract
BACKGROUND: The relationship between invasive vascular procedures and
bleeding in patients with peripheral artery disease has not been well
described in the literature. This post hoc analysis from the EUCLID trial
(Examining Use of Ticagrelor in Peripheral Artery Disease) aimed to
describe the incidence of major and minor postprocedural bleeding and
characterize the timing and severity of bleeding events relative to the
procedure. METHOD(S): EUCLID was a multicenter, randomized controlled
trial of 13885 patients with symptomatic peripheral artery disease that
tested the efficacy and safety of ticagrelor compared with clopidogrel for
the prevention of major adverse cardiovascular events. A total of 2661
patients underwent 3062 coronary revascularization, peripheral
revascularization, and amputation during the study. The primary safety end
point was Thrombolysis in Myocardial Infarction major or minor bleeding.
All bleeding events were formally adjudicated by a clinical end point
classification group. RESULT(S): Major bleeding events most often
occurred <=7 days following the procedure. The incidence of Thrombolysis
in Myocardial Infarction major or minor bleeding <=7 days following
peripheral revascularization (3.3%; 95% CI, 2.5%-4.1%) was similar to
rates after coronary revascularization (4.0%; 95% CI, 2.6%-5.4%) and lower
extremity amputation (2.3%; 95% CI, 0.8%-3.8%). The severity of bleeding
events (as graded by drop in hemoglobin, need for transfusion, bleeding in
a critical location, and fatal bleeding) was also similar following
peripheral, coronary revascularization, and lower extremity amputation.
 CONCLUSION(S): The incidence of Thrombolysis in Myocardial Infarction
major/minor bleeding following peripheral revascularization is comparable
to rates after coronary revascularization and lower extremity amputation,
and the majority of bleeding events occur within 7 days following the
procedure. The severity of periprocedural bleeding is also similar after
procedures, with the most frequently adjudicated reason being a drop in
hemoglobin >=2 g/dL. Future studies should be performed to enhance our
understanding of bleeding risk related to revascularization and amputation
procedures in peripheral artery disease patients.

<89>
Accession Number
629514110
Title
Health Status after Transcatheter vs. Surgical Aortic Valve Replacement in
Low-Risk Patients with Aortic Stenosis.
Source
Journal of the American College of Cardiology. (no pagination), 2019. Date
of Publication: 18 Sep 2019.
Author
Baron S.J.; Magnuson E.A.; Lu M.; Wang K.; Chinnakondepalli K.; Mack M.;
Thourani V.H.; Kodali S.; Makkar R.; Herrmann H.C.; Kapadia S.; Babaliaros
V.; Williams M.R.; Kereiakes D.; Zajarias A.; Alu M.C.; Webb J.G.; Smith
C.R.; Leon M.B.; Cohen D.J.
Institution
(Baron) Lahey Hospital and Medical Center, Burlington, Massachusetts;
Saint Luke's Mid America Heart Institute, University of Missouri-Kansas
City, Kansas City, Missouri
(Magnuson, Wang, Chinnakondepalli) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, Kansas City, MO, United
States
(Lu) Edwards LifeSciences, Irvine, CA
(Mack) Baylor Scott and White Healthcare, Plano, TX, United States
(Thourani) Marcus Heart and Vascular Center, Piedmont Heart Institute,
Atlanta, Georgia
(Kodali, Alu, Smith, Leon) Columbia University Medical Center, New York
City, NY, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, Mexico
(Herrmann) Hospital of University of Pennsylvania, Philadelphia, PA,
United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Babaliaros) Emory University School of Medicine, Atlanta, Georgia
(Williams) New York University Langone Medical Center, New York City, NY
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Zajarias) Washington University School of Medicine, Barnes-Jewish
Hospital, St Louis, MO, United States
(Webb) St. Paul's Hospital, University of British Columbia, Vancouver,
Canada
(Cohen) University of Missouri-Kansas City, Kansas City, MO, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: In patients with severe aortic stenosis (AS) at low surgical
risk, treatment with transcatheter aortic valve replacement (TAVR) results
in lower rates of death, stroke, and re-hospitalization at 1 year compared
with surgical aortic valve replacement; however, the effect of treatment
strategy on health status is unknown. OBJECTIVE(S): This study sought
to compare health status outcomes of TAVR vs. surgery in low-risk patients
with severe AS. METHOD(S): Between 3/2016 and 10/2017, 1000 low-risk
AS patients were randomized to transfemoral TAVR using a
balloon-expandable valve or surgery in the PARTNER 3 Trial. Health status
was assessed at baseline, 1, 6 and 12 months using the Kansas City
Cardiomyopathy Questionnaire (KCCQ), SF-36 and EQ-5D. The primary endpoint
was change in KCCQ-Overall Summary (KCCQ-OS) score over time. Longitudinal
growth curve modeling was used to compare changes in health status between
treatment groups over time. RESULT(S): At 1 month, TAVR was
associated with better health status than surgery (mean difference in
KCCQ-OS 16.0 points; p<0.001). At 6 and 12 months, health status remained
better with TAVR, although the effect was reduced (mean difference in
KCCQ-OS 2.6 and 1.8 points respectively; p<0.04 for both). The proportion
of patients with an excellent outcome (alive with KCCQ-OS >= 75 and no
significant decline from baseline) was greater with TAVR than surgery at 6
months (90.3% vs. 85.3%; p=0.03) and 12 months (87.3% vs. 82.8%; p=0.07).
 CONCLUSION(S): Among low-risk patients with severe AS, TAVR was
associated with meaningful early and late health status benefits compared
with surgery. Copyright © 2019. Published by Elsevier Inc.

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